Abstract

Study of Haemodynamic Instability in Dengue Fever and its Correlation with Thrombocytopenia, Hematocrit and Deranged Lft at Tertiary Care Hospital, RIMS, Ranchi

Background: Dengue fever has been known for more than a century in the tropical countries. Dengue fever is now the most common cause of arboviral disease in the world, with an estimated annual occurrence of 100 million cases of dengue fever and 250,000 cases of dengue haemorrhagic fever and a mortality rate of 25,000 per year. Most cases of dengue haemorrhagic fever are reported from Asia, where it is a leading cause of hospitalization and death among children. The virus seems to have some hepatotoxic effects. Affliction of liver in form of derangements in the liver function tests is common and may include mild elevations in serum bilirubin, elevated transaminases and derangements in serum albumin. Although asymptomatic in most cases, clinical manifestations like jaundice and Acute Liver Failure (ALF) may occasionally complicate the clinical picture. Indeed, dengue has been implicated as an important cause of ALF in endemic countries. Dengue is diagnosed by Reverse Transcription Polymerase Chain Reaction (RT-PCR) and detection of NS1 antigen with corresponding IgM, IgG antibodies by enzyme immunoassay and immune-chromatographic test. These tests may not be available in the periphery. So the haematological parameters like platelet count, haematocrit, leukocyte count and peripheral smear findings will aid in the diagnosis of dengue fever.

Materials and methods: 50 cases with proven diagnosis of dengue by serology were taken. Detailed history, physical examination and investigations including complete blood count, coagulation profile, and liver function tests were done. Their stay in hospital and outcome were observed.

Results: Dengue infection was more common in adult age group with slight male preponderance (38/50). It presented commonly as dengue fever with other constitutional symptoms. Petechial ecchymosis was the most common sign elicited clinically (19/50). Haematological findings like raised hemotocrit (30/50) with decreased platelet count (30/50) were seen in majority of the cases. Supportive treatment was the mainstay mode of management.

Conclusion: Raised hematocrit, thrombocytopenia, leucopenia and atypical lymphocytes in the peripheral smear will aid in early diagnosis of dengue infection. Early recognition and prevention rather than treatment of complications is most important for favourable outcome of the disease.

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