Risk factors and clinical outcome of profound thrombocytopenia in adult patients with DENV infections

Dhanoa, Amreeta; Rajasekaram, Ganeswrie; Hassan, Sharifah Syed; Ramadas, Amutha; Adnan, Nur Amelia Azreen; Lau, Chun Fatt; Chan, Teik Seng; Ngim, Chin Fang

doi:10.1080/09537104.2017.1293802

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…Bone marrow suppression and platelet destruction have been hypothesized as the cause of thrombocytopenia in DENV infections, with a rapid decrease in platelet counts constituting a WHO dengue warning sign [ 4 , 23 , 28 ]. Platelet levels generally show a dynamic decline, reaching a nadir by 3 to 6 days of fever onset [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Major haemorrhage referred to clinically significant bleeding requiring red cell transfusion whereas, minor haemorrhage referred to mucosal bleeding such as gum bleeding, nasal bleeding not requiring red cell transfusion [ 23 ]. Severe thrombocytopenia was defined as platelet count < 50,000/ mm 3 , a level shown to be associated with additional severe manifestations [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

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The association between obesity and dengue virus (DENV) infection in hospitalised patients

et al. 2018

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Both obesity and DENV infections are growing public health concerns that have far-ranging socioeconomic effects, especially in developing countries. Despite the increasing prevalence of these conditions, there is a scarcity of data investigating the potential relationships between these two entities. Our study aims to examine the influence of obesity on various clinical and laboratory parameters amongst patients with DENV infections. A total of 335 hospitalized patients aged >12 years who were DENV non-structural protein 1 (NS1) antigen-positive were enrolled in this study. Clinical and laboratory variables were compared between patients with and without obesity. Multivariate analysis showed that the following admission clinical findings and laboratory results were independently associated with obesity; chills and rigors (AOR:2.653, 95% CI: 1.286–5.474), higher temperature (AOR:1.485, 95% CI: 1.080–2.042), higher systolic BP (AOR:1.057, 95% CI:1.037–1.078), raised haematocrit (AOR: 1.953, 95% CI: 1.010–3.778), elevated creatinine (AOR:3.504, 95% CI:1.351–9.008) and elevated ALT (AOR: 4.146, 95% CI:1.878–9.154). Obesity was found to be significantly associated with hospitalization >3 days (AOR: 1.990, 95% CI: 1.134–3.494) and the presence of increasing haematocrit with decreasing platelets (AOR: 2.134, 95% CI = 1.235–3.688). Serial assessment of laboratory data revealed that peak haematocrit was significantly higher and nadir platelets levels were significantly lower in obese patients. Both peak and admission levels of leukocyte counts, AST, ALT and creatinine were significantly higher in the obese group. Conversely, both admission and nadir albumin levels were lower for the obese group, although only nadir albumin levels achieved statistical significance. These findings support closer clinical monitoring of obese patients who present with DENV infections, as this patient cohort may possess an increased tendency towards developing more severe clinical manifestations of DENV infections as compared to non-obese patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The association between obesity and dengue virus (DENV) infection in hospitalised patients

et al. 2018

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“…The clinical presentations of dengue fever range from a self-limited febrile illness to dengue hemorrhagic fever, characterized by plasma leakage, plasma concentration, and hypoalbuminemia and profound thrombocytopenia. 3…”

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An Usual Cause of Massive Upper Gastrointestinal Bleeding

Elmakki

2018

Gastroenterology

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Question: A 48-year-old man was referred to our hospital with a 12-hour history of acute massive upper gastrointestinal (GI) bleeding. He denied previous similar episodes or chronic medical illnesses. Two days before admission, he was seen in another hospital for acute febrile illness, for which he was given an empirical antibiotic in a form of clavulanted amoxicillin and oral paracetamol, and his fever subsided. On the day of admission, he developed severe hematemesis and hematochezia, but no bleeding from other sites. On arrival to our hospital, he was very pale, afebrile, and hemodynamically unstable with a pulse rate of 120 beats/min and a blood pressure of 80/50 mm Hg. He exhibited no peripheral stigmata of chronic liver disease, and the abdominal examination disclosed no organomegaly or ascites. The liver span was within normal limits. Physical examination of other systems was unremarkable. His initial laboratory tests revealed low hemoglobin (6 g/dL), a platelet count of 50,000/cm 3 leucopenia, high prothrombin time and partial thromboplastin time, normal D-dimer, normal renal function tests and normal liver function tests, except for hypoalbuminemia. Ultrasound examination of the abdomen showed normal liver texture and no features suggestive of portal hypertension. After intensive resuscitation (with intravenous fluids, blood, fresh frozen plasma, and platelet transfusion) urgent upper GI endoscopy was done (Figure A, B). The next day, again he developed severe upper GI bleeding and lapsed into hypovolemic shock. He was resuscitated and underwent repeat upper GI endoscopy, which showed the same findings. On the same, day his platelet count decreased to 35,000/cm 3. Blood culture was negative for gram-positive organisms, gram-negative organisms, and anaerobes. He was given platelet and fresh frozen plasma transfusions. His condition gradually improved. A few days later, he was discharged in good condition with normal complete blood counts. What is the most likely diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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“…Most clinical guidelines recommend platelet transfusion in patients with dengue who develop severe bleeding or platelet counts below 10-20,000/mm 3 . However, another study confirms that platelet transfusion does not prevent the development of severe bleeding or shorten coagulation time [55], and in severe dengue disease with hemorrhagic manifestations, the need for intensive care was not significantly associated with PT [52].…”

Section: Thrombocytopenia Induced By Bone Marrow Suppression Lysis Omentioning

confidence: 99%

“…The kinetic observation of platelet counts in dengue patients showed a mild to moderate decrease in the 3rd to the 7th day, a significant decrease on day 4, reaching normal levels in the 8th or 9th day of the disease [50,51]. Profound thrombocytopenia (nadir platelet count ≤20,000/mm 3 ) was significantly more likely to detect early warning signs and longer hospital stays, but profound thrombocytopenia was not affected by DENV serotypes, coinfections, and secondary DENV infections [52]. However, a study involving 245 dengue patients showed no relationship between bleeding and platelet count, while 81 nonbleeding patients had a score below 20,000/mm 3 [53].…”

Section: Thrombocytopenia Induced By Bone Marrow Suppression Lysis Omentioning

confidence: 99%

A View of Platelets in Dengue

Azamor¹,

de-Oliveira-Pinto²

2018

Thrombocytopenia

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Platelets were mainly associated with coagulation and hemostasis; however, other biological effects have been attributed to platelets, including angiogenesis, extracellular matrix synthesis, inflammation, and immune response. Dengue virus infection causes 200 million cases of severe flu-like illness annually, escalating to life-threatening hemorrhagic fever or shock syndrome. Some hypotheses are postulated for immunopathogenesis of dengue, including antibody enhancement theory, T-cell activation of cross-reactive memory, and original antigenic sin. All hypotheses, to some extent, induce an overproduction or a skewed profile of cytokine release, giving rise to the term cytokine storm/cytokine tsunami. Although thrombocytopenia is typical of both mild and severe diseases, the mechanism triggering platelet reduction is incompletely understood. In dengue, platelets are one of the major cell populations affected by direct and/or indirect mechanisms of infection. It is common to observe both thrombocytopenia and platelet dysfunction in dengue, both strongly related to the clinical outcome. Thus, platelets are frequently affected in dengue, either for alteration of their own functionality, for "silent transport" of virus, or as an anti-viral immune cell. In this way, we describe some of functional aspects of platelets on dengue, observing circulating mediators, intraplatelet proteins contents, morphology, activation markers, and ability to interact with dengue virus.

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Risk factors and clinical outcome of profound thrombocytopenia in adult patients with DENV infections

Cited by 11 publications

References 13 publications

The association between obesity and dengue virus (DENV) infection in hospitalised patients

The association between obesity and dengue virus (DENV) infection in hospitalised patients

An Usual Cause of Massive Upper Gastrointestinal Bleeding

A View of Platelets in Dengue

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