254 - A Challenging Oral Course After Bone Marrow Transplant

Abstract:

Introduction: Beta-thalassemia is a common hereditary hematologic disorder of which the primary concern is ineffective erythropoiesis. It is classified into 3 forms based on severity: major, intermedia, and minor. Patients with Beta-thalassemia major are dependent on lifelong blood transfusions which compensate for anemia and increase survival. The most common complication of repeated blood transfusions is iron overload resulting in potentially fatal levels of iron deposits in various organs. Bone marrow transplant (BMT) is the only curative treatment for Beta-thalassemia major.



Case Report: This presentation discusses a 9-year-old male with Beta-thalassemia major who presented to Children’s Wisconsin for BMT following iron overload complications after repeat blood transfusions. The patient was matched for transplant with his unaffected sibling. He was referred to the Children’s Wisconsin Dental Center for pre-BMT clearance exam 12 days before his procedure and was deemed caries and infection free. One month after transplant, a dental consultation was requested for additional recommendations on mucositis management due to worsening oral pain, mouth bleeding, and non-healing lesions. Mucosal lesions were recorded to have progressed to red, erosive lesions on attached gingiva, vestibule, lips, and hard palate with pain that was unable to be well controlled via patient-controlled analgesia, ketamine drip, or oral lidocaine rinse. A biopsy of outer lip lesions was sent for histological examination. This report will detail the clinical progression and differential diagnoses of oral complications associated with BMT and Beta-thalassemia and the multi-disciplinary teams involved in the treatment rendered.

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