Pathology · patient case with 2 questions
Patient with leukaemia presenting with oral infection
Patient: Adult with a recent diagnosis of leukaemia
Chief complaint: Recurrent mouth infections and sore gums.
Background: Undergoing haematological workup. No radiotherapy to the head and neck.
Current findings: Generalised gingival inflammation and a poorly localised soft tissue infection.
Question 1
Why is this patient at high risk of infection?
Show answer and explanation
Correct answer: B. Leukaemia produces large numbers of immature, dysfunctional white cells that cannot mount an effective defence
- A. Complement deficiency is not a feature of leukaemia.
- B. CORRECT. In leukaemia the marrow is overrun by a malignant clone. The white cell COUNT may be high, normal or low, but the cells are immature and functionally incompetent, and normal haematopoiesis is crowded out. The result is functional neutropenia — the patient cannot fight bacteria despite the numbers on the count.
- C. This patient has had no head and neck radiotherapy.
- D. Hygiene contributes to gingival inflammation but does not explain the systemic susceptibility.
Note: Key trap: a HIGH white cell count in leukaemia does not mean good immunity. Function, not number, determines defence.
Question 2
Which peripheral blood change is most characteristic of an ACUTE dentoalveolar abscess in an otherwise healthy patient?
Show answer and explanation
Correct answer: A. Leukocytosis with neutrophil predominance
- A. CORRECT. A pyogenic bacterial infection drives neutrophils out of the marrow, producing LEUKOCYTOSIS, typically 12,000–20,000/mm³ with a left shift. The neutrophils constitute the pus itself.
- B. Neutropenia predisposes TO severe infection rather than resulting from one.
- C. Lymphocytosis is the pattern of viral and certain chronic infections.
- D. Leukopenia signals marrow failure or overwhelming sepsis — an ominous finding requiring urgent medical referral.