CASE 2 — Leukemia patient on active chemotherapy. What is the primary concern when treating this patient due to her medications?

Correct answer: D. Infection risk from low white blood cell count (neutropenia)

• A. Certain chemotherapy regimens (with corticosteroids) can raise blood sugar, but immunosuppression is the dominant dental concern.
• B. Adrenal crisis is a concern with long-term corticosteroid use, not primarily chemotherapy.
• C. Hypothyroid crisis is not a direct complication of standard leukemia chemotherapy.
• D. Chemotherapy causes myelosuppression → neutropenia (low ANC/WBC) → severely compromised immunity. This is the PRIMARY dental concern. Oral procedures can introduce bacteria into the bloodstream of an immunocompromised patient, potentially causing sepsis. An ANC <500/μL is a relative contraindication to elective dental procedures.