{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:40:08Z","timestamp":1756377608940,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,12,26]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>Gingival bleeding is a common intraoral finding, typically associated with inflamed tissues and periodontal disease. It is easily provoked by periodontal probing or toothbrushing. Spontaneous gingival bleeding rarely occurs and may be the only sign of systemic bleeding problems such as thrombocytopenia, leukaemia or coagulopathy. In pregnancy, acute onset of thrombocytopenia may occur in systemic disorders such as severe pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) or the acute fatty liver of pregnancy. The diagnosis and management of such conditions may challenge physicians. It requires a systematic approach with a comprehensive history to exclude causes of gingival haemorrhage such as periodontal disease, anticoagulant therapy, maxillofacial trauma, haematological disorders or a bacterial infection. The authors describe a case of immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. This case highlights the fact that medical intervention to correct the underlying aberration of haemostasis is necessary for local measures to stop the gingival bleeding successfully.<\/jats:p>","DOI":"10.1136\/bcr-2018-228309","type":"journal-article","created":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T04:18:22Z","timestamp":1547785102000},"page":"e228309","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy"],"prefix":"10.1136","volume":"12","author":[{"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Department of Surgery, Milton Keynes University Hospital, Milton Keynes, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhodri","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, The Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,17]]},"reference":[{"key":"2025082803182760000_12.1.e228309.1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-07-162503"},{"key":"2025082803182760000_12.1.e228309.2","first-page":"197","article-title":"Significance of periodontal health in primary immune thrombocytopenia - a case report and review of literature","volume":"10","author":"Sangwan","year":"2013","journal-title":"J Dent"},{"key":"2025082803182760000_12.1.e228309.3","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-201778"},{"key":"2025082803182760000_12.1.e228309.4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1056\/NEJMoa1802897","article-title":"Platelet counts during pregnancy","volume":"379","author":"Reese","year":"2018","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082803182760000_12.1.e228309.5","doi-asserted-by":"publisher","DOI":"10.4065\/79.4.504"},{"key":"2025082803182760000_12.1.e228309.6","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-08-448944"},{"key":"2025082803182760000_12.1.e228309.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0037-1963(00)90106-9"},{"key":"2025082803182760000_12.1.e228309.8","unstructured":"Rajaswkhar A , Gernsheimer T , Stasi R , et al . 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European Federation of Periodontology. Women\u2019s Oral Health in Pregnancy. https:\/\/www.efp.org\/publications\/projects\/oralhealthandpregnancy\/."},{"key":"2025082803182760000_12.1.e228309.16","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1999.4.1.1"},{"key":"2025082803182760000_12.1.e228309.17","doi-asserted-by":"publisher","DOI":"10.1080\/00016350260248210"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:18:36Z","timestamp":1756376316000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,17]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/bcr-2018-228309"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228309","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}