Pancytopenia Oral Signs — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementPancytopenia Oral SignsORE Part 1

A patient has oral ulceration and spontaneous gingival bleeding. Their full blood count shows: white cell count 2.1 × 10⁹/L, neutrophils 0.6 × 10⁹/L, haemoglobin 88 g/L and platelets 42 × 10⁹/L. Which diagnosis best accounts for this presentation?

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Correct answer: C — Pancytopenia due to marrow disease

The simultaneous low haemoglobin, white-cell/neutrophil count and platelet count is pancytopenia. Severe neutropenia plausibly contributes to oral ulceration through impaired host defence, while thrombocytopenia explains spontaneous gingival bleeding. This combination should prompt urgent medical/haematology assessment for an underlying cause, including acute leukaemia, aplastic anaemia or another marrow disorder. Iron deficiency causes anaemia but does not usually cause marked neutropenia and thrombocytopenia. Periodontitis is a local disease and cannot explain the full blood-count pattern. Vitamin C deficiency may cause gingival bleeding but not this trilineage cytopenia. Warfarin excess can increase bleeding but does not lower white cells, haemoglobin and platelets in this pattern.

Reference: Chew S, Kamangar M. Approach to pancytopenia: From blood tests to the bedside. Clinical Medicine (London), 2024. https://pubmed.ncbi.nlm.nih.gov/39159748/