J Periodontol • March 2004 483 Severe Gingival Bleeding in a Myelodysplastic Patient: Management and Outcome Claudio M. Pereira,* Patrícia F. Gasparetto, † Fábio L. Coracin, † José F. Marquês, ‡ Carmen S.P. Lima, ‡ and Maria E.P. Corrêa † Case Report Background: The myelodysplastic syndromes (MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. Oral manifestations of the disease and oral com- plications of medical management may result in signif- icant symptoms and have an impact on the systemic condition of the patient. The removal of the infectious focus, such active teeth infection or severe periodontal disease, remains controversial in these patients, due to the increased risk of bleeding and systemic infection. Methods: This paper reports a case of MDS with spontaneous gingival hemorrhage and generalized gin- gival hyperplasia associated with periodontal disease. This patient underwent several platelet transfusions due to these oral complications. The patient received periodontal therapy, resulting in an improvement of the oral clinical situation and a decrease of gingival hyperplasia. Results: The patient did not present any episode of gingival hemorrhage after the periodontal treatment. Conclusion: The results of this study suggest that periodontal therapy should be performed in MDS patients presenting thrombocytopenia, gingival hyper- plasia, and gingival bleeding, with the intent of pre- venting further hemorrhagic episodes and possible systemic infection. J Periodontol 2004;75:483-486. KEY WORDS Gingival hemorrhage; gingival hyperplasia; myelodysplastic syndrome/diagnosis and control. Myelodysplastic syndrome (MDS) represents an un- common group of clonal disorders of hemopoietic stem cells, characterized by peripheral cytopenias, due to abnormal hemopoietic differentiation and maturation. The cytopenias are usually associated with a hyper- plastic marrow with trilineage dysplasia and variable progression to overt acute leukemia. 1,2 Although ane- mia is observed in 90% of patients at the beginning of the disease, neutropenia and thrombocytopenia are also common findings and often require transfusion support and antibiotics. 3,4 The French-American-British (FAB) classification identified five subtypes of the disease with progressive reduction of median survival probability and increas- ing risk of evolution into frank acute myelogenous leukemia. These subtypes are refractory anemia (RA), RA with ringed sideroblasts (RARS), RA with excess blasts (RAEB), RAEB in transformation, and chronic myelomonocytic leukemia (CMML). 1,2 The incidence of oral complications in the myelo- proliferative disorders, including MDS, is estimated to range between 15% to 85%. 5 Oral manifestations and complications of their management include paresthe- sias, petechiae, burning mouth, gingival hyperplasia and ulceration, hemorrhage, hairy leukoplakia, persis- tent herpes labialis, mucositis, infection, alteration or loss of taste, xerostomia, pain, and associated diet and nutritional concerns. 5-10 A case of MDS with generalized gingival hyperplasia associated with periodontal disease and spontaneous gingival hemorrhage is reported here. This patient underwent several platelet transfusions due to these oral manifestations and experienced a good improvement in her oral clinical status after periodontal therapy. CASE REPORT AND RESULTS A 42-year-old female was admitted in December 1999 to the Hemocentro-University of Campinas (UNI- CAMP), with complaints of weakness and several episodes of gingival bleeding. Anemia, neutropenia, and thrombocytopenia were found in the peripheral blood examination. After bone marrow scrubbing and karyotyping, diagnosis of MDS subtype RARS was * Oral Semiology and Oral Pathology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil. † Dentistry Ambulatory, Hematology and Hemotherapy Center, State University of Campinas. ‡ Hematology Ambulatory, Hematology and Hemotherapy Center, State University of Campinas.