Severe Thrombocytopenia Oral Signs — ORE Part 1 MCQ
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Correct answer: B — Immune thrombocytopenia or marrow disease
**A is correct.** Oral petechiae and spontaneous gingival bleeding are a mucocutaneous bleeding pattern typical of thrombocytopenia. The measured platelet count of 20 × 10⁹/L is severely reduced; UK NHS guidance notes that petechiae become more likely below this level and gum bleeding may occur. Immune thrombocytopenia is an important cause of isolated thrombocytopenia, while marrow disease, including haematological malignancy, is an important alternative cause requiring medical assessment. Periodontitis and scurvy can cause gingival bleeding but do not explain this severe thrombocytopenia. Haemophilia A and von Willebrand disease impair coagulation or platelet adhesion/function, respectively, but usually do not produce a platelet count of 20 × 10⁹/L. The decisive finding is therefore the profound reduction in platelet number.
Reference: Norfolk and Norwich University Hospitals NHS Foundation Trust, "Immune thrombocytopenia", accessed July 2026. https://www.nnuh.nhs.uk/departments/haematology-department/non-malignant-haematology/immune-thrombocytopenia/