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Quantitative disorder of white blood cells - Leukopenia

Leukopenia is known as the decrease in white blood cell count in blood (under 4.000 - 4.500/mm³.) It is usually related to decrease in neutrophil count. Decreased production of neutrophils is associated with deficiencies of vitamin B12 and folic acid, aplastic anemia, tumors, drugs, metabolic disease, nutritional deficiency and immune mechanisms. In general, the most common oral manifestations of neutropenia include ulcer, gingivitis and periodontitis. Agranulocytosis can be presented as whitish or greyish necrotic ulcer in oral cavity, without any sign of inflammation. Acquired agranulocytosis is much more common than congenital form. The common causes of acquired agranulocytosis including drugs (non-steroidal anti-inflammatory drugs, antiepileptics, antithyroid and antibiotics) and viral infection. Agranulocytosis has a mortality rate of 7-10%. To manage this, the application of granulocyte growth factor (G-CSF) or granulocyte transfusion and the use of broad spectrum antibiotics to protect bacterial infections are recommended.

Quantitative disorder of white blood cells - Chediak Higashi syndrome

In Chèdiak-Higashi syndrome, the lysosomal trafficking regulator (LYST) gene is mutated, leading to disruption of protein synthesis as well as the storage and secretory function of lysosomal granules in white blood cells. This results in defective white blood cell function with enlarged vesicles. This syndrome also leads to neutropenia and phagocyte bactericidal dysfunction due to impaired chemotaxis. Deficiency in serotonin and adenosine-phosphate-containing granules in platelets causes impaired platelet aggregation, leading to prolonged bleeding time. Thus, patients are susceptible to infections and often present with oculo-cutaneous albinism and coagulation defects. Patients often present with early-onset aggressive periodontitis associated with advanced alveolar bone loss and tooth mobility due to neutropenia and defective neutrophil function. Recurrent oral ulcerations is also one of the common oral manifestations in patient with this disease.