Haematological features and differentiation of recurrent oral ulceration

Abstract

A prospective study was carried out over a period of 4 years to determine the role of anaemia, vitamin B 12 folate or iron deficiency in the pathogenesis of minor, major and herpetiform ulcers. A series of 193 patients with recurrent oral ulceration (ROU) was examined clinically and haematologically and the results were compared with those from 80 patients with other types of oral ulcers, 204 patients with non-ulcerative oral diseases and 100 controls. A small number of patients with ROU were found to be anaemic due to iron deficiency (4·7 per cent), vitamin B 12 deficiency (0·5 per cent) or folate deficiency (2·1 per cent). The low prevalence suggests that anaemia does not play a primary aetiological role in ROU. Subnormal serum iron levels without anaemia (sideropenia) were found in 20 per cent of patients with ROU, but also in 20 per cent of those with other oral ulcers, in 13 per cent with other oral diseases and 5 per cent of the controls. The findings of an increased prevalence of sideropenia in both ROU and in patients with other oral ulcers, a correlation between severity of ulceration and sideropenia and a failure by most patients to respond clinically to iron therapy, suggest that sideropenia is secondary to the oral ulceration. Patients with minor aphthous ulcers did not show an increased prevalence of any haematological deficiency in comparison with controls. In a small number of patients ROU was associated with systemic diseases and iron deficiency or macrocytic anaemia; these ulcers could be distinguished from minor, major and herpetiform ulcers by careful clinical and haematological assessment and are termed pseudominor, pseudo-major and pseudo-herpetiform ulcers.