Dental Treatment in Patients with Leukemia

Table 1

Minimum haematological values for performance of invasive dental procedures in prechemotherapy treatment patients according to different authors.

Authors	Platelet count	Neutrophil count
Eversole et al., 2001 [33]	<50,000 : not perform dental or periodontal surgery in office setting.	—
Little et al., 2007 [5]	<50,000 : avoid invasive procedures.; <40,000 : perform transfusions in invasive procedures.	<500 : antimicrobial prophylaxis (or with leukocytes <2,000 cells/mm^3).
American Academy of Pediatric Dentistry, 2013 [1]	>75,000 : without additional support.; 40,000 to 75,000 : Platelet transfusion may be considered in the preoperative and postoperative (24 hours).; <40,000 : Postpone the dental treatment. In the case of dental emergency, contact the patient's physician before dental treatment to discuss supportive measures, such as platelet transfusion, control of bleeding, and need for hospitalization.; Other coagulation tests may be necessary in some cases.	>1,000 : no need for antibiotic prophylaxis. Some authors suggest that prophylaxis is performed with values between 1,000 and 2,000cell/mm^3 (following recommendations of the American Heart Association). If infection is present or there is doubt, more aggressive antibiotic prophylaxis may be indicated and should be discussed with the medical team.; <1,000 : Postpone the dental treatment. In cases of emergency, discuss antibiotic coverage and endocarditis prophylaxis before treatment with the medical team. Hospitalization may be required.
US National Cancer Institute, 2011 [2]	>60,000 : without additional support.; 30,000  to 60,000 : optional transfusion for noninvasive procedure.; <30,000 : Platelets should be transfused 1 h before the procedure. Obtain immediate postinfusion platelet count; transfuse regularly to maintain counts >30,000–40,000 cell/mm^3 until the start of healing.	>2,000 : without the need for antibiotic prophylaxis.; 1,000 to 2,000 : antibiotic prophylaxis (low risk).; <1,000 : antibiotic prophylaxis with Amikacin 150 mg/m^2 1 h before surgery and Ticarcillin 75 mg/Kg IV 1 h before surgery. Repeat both 6 h postoperative.