The case
A 56 year old male reported to the outpatient Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College with a complaint of bleeding from extraction socket of left first mandibular molar. Patient self-extracted the aforementioned tooth 6 days back. Even after elapsing of 2 hours after extraction the bleeding ceased to stop. This raised an alarm in the patients mind. He went to the same Dentist where suturing of the socket was done, evident by the residual suture tags. Even after that oozing was present from extraction site. Patient did not pay much attention to the ooze and continued his daily activities in the anticipation of stoppage of bleeding over course of time. He gave no history of any bleeding or clotting disorder, hemophilia, episode of myocardial infarction or any other systemic condition. He gave history of chronic alcohol consumption. He presented with no history of long term medication known to impede blood clot formation or blood thinning therapy
Intra-oral examination revealed continuous ooze from the socket. Buccal cortical plate was found to be missing. Clots from around the surgical site were retrieved. Local hemostatic control measures yielded no encouraging results. On systemic inspection Petechiae were found on the chest and back region. At the outset patient was reluctant to get admitted in anticipation of a minor problem. On persistent persuasion and counselling he and his relatives agreed upon. Preliminary hematological investigations were performed .MCV (Mean corpuscular volume) was found to be 132 FL, MCH (Mean corpuscular hemoglobin) 40Pg, hematocrit value was found to be 35.1, MCHC (Mean corpuscular hemoglobin concentration) of 30.1 which suggested of macrocytic anemia. This could be attributed to his habit of chronic alcoholism .Prothrombin time was found to be 16 seconds. He was found to be thrombocytopenic having a platelet count of 20000/mm3.Peripheral smear was suggestive of acute myeloid leukemia. Bone marrow biopsy was planned to confirm the diagnosis At this point of time initial focus of treatment was on controlling acute bleeding. Local hemostatic measure in form of gelatin sponge packing followed by suturing was instituted. Systemic administration of Vitamin K yielded no encouraging results. Infusion of fresh frozen plasma was about to be initiated.
Following this patient went unconscious. He was immediately intubated.
Computed tomography revealed intra-parenchymal bleed in left fronto-parieto-temporal and gangliocapsular region. Epidural, subdural and subarachnoid hemorrhage too was observed. (Fig.1) Patient was immediately shifted to Department of Neurosciences for management. In the course of treatment he did not improve and eventually succumbed.