Secondary syndrome may be present. (3) Trombocytopenia

Secondary manifestation are due to the suppression of normal
hematopoietic bone marrow (anemia, leucopenia, trombocytopenia) with general
symptoms like weakness, constant fatigue, dyspnea, pallor, fever, infection,
weight loss, spontaneous bleeding, petechiae, ecchymoses, epistaxes,
menorrhagia and bruising. Anemia is
a disordered process in which the rate of red cell production fails to match
the rate of destruction, resulting in a reduction in hemoglobin concentration. (3) Intraorally generalized mucosal
pallor, non-specific oral erythema or cyanosis may be present. (1) Specifis entities like angular
cheilitis, glossitis with different degrees of atrophy of fungiform and
filliform papillae, oral candidiasis, recurrent aphthous stomatitis,
erythematous mucositis and burning mouth syndrome may be present. (3) Trombocytopenia is a condition
characterized by abnormally low levels of thrombocytes, and manifastates as spontaneous
prolonged and profuse mucosal hemorrhage or after trivial trauma.  Typical localization of profuse bleeding is
gingiva. Leukopenia is a decrease in
the number of white blood cells. Generally, quantitative polymorfonuclear
deficiencies (neutropenia) are accompanied by recurrent gingivitis, generalized
periodontal destruction and oral ulceration. (3, 16) Erosions and painful or necrotic ulcerations occur as a
result of infection by normal oral flora in the setting of neutropenia of as
direct leukemic infiltration (A) Increased
susceptibility to opportunistic infection due to leukopenia is well documented
e.g. viral (herpes simplex stomatitis HSV, cytomegaloviral stomatitis CMV varicella zoster virus,
Epstein-Barr virus, respiratory viral infections, hepatitis viral infections,
and gastrointestinal infection??) fungal (oral candidiasis) and
bacterial infections (acute necrotizing ulceratice gingivostomatitis) or
reactivation of latent infections such as osteomyelitis, pericoronitis,
periodontal, or periapical persistent and prominently painful inflammations. Healing
responses after tooth extraction can be altered. (A) Palatal ulcerations and necrosis can be caused by acute opportunistic fungal infection mucormicosis, which usually begins in the
nose and paranasal sinuses. This fungus invades the arteries, forms thrombi
within the blood vessels that reduce blood supply and cause necrosis of hard
and soft tissues. Numerous predisposing risk factors are associated with
mucormycosis, although most cases have been reported in poorly controlled
diabetics or in patients with hematological malignancies such as acute leukemia. (4, 5)