Clinical Study of Thrombocytopenia in Dengue Fever

Abstract

INTORODUCTION: Dengue is a mosquito-borne viral disease by Flaviviridae family causing wide spectrum of disease ranging from subclinical disease, severe flu-like symptoms to severe dengue associated with severe bleeding, organ impairment and/or plasma leakage with higher risk of death when not managed appropriately. WHO classifies as DF/ DHF/DSS earlier, at present as Dengue (with or without warning signs) and Severe Dengue. The virus may be detected by NS1antigen and by ELISA IgM IgG antibodies. Thrombocytopenia is one of the laboratory parameter in grading severity, a study is planned during an epidemic in south Karnataka region which would have a substantial impact on management by reducing morbidity and mortality associated with dengue.

AIMS AND OBJECTIVES: To correlate warning signs, laboratory parameters in different age groups, sex, with severity of thrombocytopenia with management.

MATERIAL AND METHODS: Prospective observational study conducted at south Karnataka for patients more than 15 years with Dengue NS1Antigen positive or IgM/IgG positive and Platelet count less than 1, 50,000 per dl. Detailed clinical history and detailed physical examination was recorded in a prescribed preform  and subjected to Dengue NS1Antigen, IgM and IgG antibodies, Complete blood count, Random Blood Sugar, Urine analysis, Liver Function tests, Renal Function tests, Abdominal sonography, ECG and managed conservatively. Data was entered in Microsoft Office Excel Sheet 2010 and analyzed.

RESULTS: There are 124 thrombocytopenia, out of which 76 severe,34 moderate and 14 mild thrombocytopenia ,74(60%) are NS1 positive and 57(46%) are IgM positive,79 males (64%)  and 45 females (36%), 49%are in 15-30 age (12% in 15-20, 37% in 21-30)and 20% in 31-40age, commonest clinical presentations along with fever are Headache 70%, myalgia 68%, nausea and vomiting  41%, arthralgia 27%, warning signs are abdominal pain 18%, bleeding manifestations 6%, restlessness  8%, altered sensorium 4%,  bradycardia 26%, hypotension 17%, hepatomegaly 11%, abnormal laboratory parameters  are leucopenia in 43%, abnormal renal function tests in 20%, elevated liver enzymes in 35% cases88%.There are 88% Dengue with warning signs,24% Severe Dengue with 17% circulatory collapse, 14% renal, 8% hepatic and 4% nervous involvement. Platelet transfusion done only in 27%.

CONCLUSION: Moderate to severe thrombocytopenia in young adults with NS1 / IgM positive is the  commonest warning sign followed by abdominal pain, bleeding manifestations, restlessness, altered sensorium, leucopenia, bradycardia,  hypotension, polyserositis, abdominal tenderness, hepatomegaly, elevated liver enzymes, hyperbilirubinemia, abnormal renal function tests . Majority require supportive management and maynot require platelet transfusion. Early recognition of warning signs and meticulous management can reduce the morbidity and mortality of dengue.