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Management of intraoral bleeding in patients with Waldenström macroglobulinemia: A protocol proposal
Sei Ueda1,2, Kou Ishii2, Hitoshi Fujii2
1Department of Maxillofacial Surgery, School of Dentistry, Aichi-gakuin University, Nagoya, Japan.
Aim:
Waldenström macroglobulinemia is a type of non-Hodgkin lymphoma with poor prognosis observed in patients with hyperviscosity syndrome because of its tendency for fatal symptoms. This study investigated the risk of intraoral bleeding in patients with Waldenström macroglobulinemia based on hyperviscosity syndrome stage and oral health status, and described potential strategies for managing intraoral bleeding.
Methods And Results:
Between April 2012 and March 2017, seven patients with Waldenström macroglobulinemia underwent dental procedures or tooth extraction. Patient records were retrospectively reviewed to obtain data of symptoms, clinical and radiographic findings, treatment details, pretreatment hematological findings, hyperviscosity syndrome status, perioperative method for local haemostasis, postoperative bleeding, and prognosis. The mean patient age was 71.2 years, and the male-to-female ratio was 6:1. Treatment modalities for oral management comprised tooth extraction, scaling, and oral cavity cleaning. Three patients were admitted for hyperviscosity syndrome; one of the patients exhibited postoperative bleeding because of poor oral hygiene, whereas the two other patients with good oral hygiene did not experience intraoral bleeding regardless of the presence of hyperviscosity syndrome.
Conclusion:
We recommended that the risk of oral bleeding in patients with Waldenstrom's macroglobulinemia should be assessed for oral health in addition to the stage of hyperviscosity syndrome.
Insights
Patients with Waldenström macroglobulinemia and hyperviscosity syndrome face intraoral bleeding risks. Good oral hygiene significantly reduces this risk, even with advanced hyperviscosity syndrome.
Area of Science:
- Hematology
- Oncology
- Oral Medicine
Background:
- Waldenström macroglobulinemia (WM) is a rare non-Hodgkin lymphoma.
- Hyperviscosity syndrome in WM patients often leads to severe, fatal symptoms.
- Intraoral bleeding is a significant concern in WM patients, particularly those with hyperviscosity syndrome.
Purpose of the Study:
- To investigate the risk of intraoral bleeding in WM patients.
- To correlate bleeding risk with hyperviscosity syndrome stage and oral health status.
- To outline management strategies for intraoral bleeding in this patient population.
Main Methods:
- Retrospective review of seven WM patients undergoing dental procedures or extraction (April 2012-March 2017).
- Data collected included symptoms, clinical/radiographic findings, treatments, hematological data, hyperviscosity status, hemostasis methods, and outcomes.
- Analysis focused on the relationship between hyperviscosity syndrome, oral hygiene, and postoperative bleeding.
Main Results:
- Three patients had hyperviscosity syndrome; one with poor oral hygiene experienced postoperative bleeding.
- Two patients with good oral hygiene did not exhibit bleeding, irrespective of hyperviscosity syndrome.
- Mean patient age was 71.2 years; male-to-female ratio was 6:1.
Conclusions:
- Oral health status is a critical factor in assessing intraoral bleeding risk for WM patients.
- Bleeding risk assessment should consider both hyperviscosity syndrome stage and oral hygiene.
- Maintaining good oral hygiene may mitigate bleeding complications in WM patients.
