%0 Journal Article
%T Haematological Disturbances in Dengue Haemorrhagic Fever - Its Pathogenesis and Management Perspectives - Haematological Disturbances in Dengue Haemorrhagic Fever - Its Pathogenesis and Management Perspectives - Open Access Pub
%A Kolitha H Sellahewa
%J OAP | Home | Journal of Hematology and Oncology Research | Open Access Pub
%D 2018
%X Haemorrhage is common to both dengue fever (DF) and dengue haemorrhagic fever (DHF). Thrombocytopaenia is exceedingly common, while prolonged partial thromboplastin time and reduced fibrinogen concentration are the other abnormal haemostatic indices evident from early in the disease course. These haematological abnormalities correlate better with the timing and severity of plasma leakage rather than the clinical haemorrhagic manifestations. Blood products including prophylactic platelet transfusions are hardly required in the management of DHF. Judicious fluid therapy is the most effective intervention to prevent complications and bleeding in DHF. Concealed haemorrhage is an important complication requiring early recognition and blood transfusions to improve outcomes. Understanding the pathogenesis of coagulopathy and the significance of altered haemostatic indices, and its co-relation to disease severity and phase of DHF, is essential for appropriate interventions particularly when DHF co-exists in patients on mandatory anticoagulation for prosthetic heart valves and atrial fibrillation. DOI 10.14302/issn.2372-6601.jhor-14-381 Infection by any one of the four serotypes of dengue virus (DENV) remains asymptomatic in the vast majority. Clinical spectrum among symptomatic infection ranges from undifferentiated fever (viral syndrome), DF, and DHF to the expanded dengue syndrome with isolated organopathy (unusual manifestations). The commonest clinical types are DF and DHF and bleeding manifestations are common to both. Severe disease including shock is exclusive to DHF, which has plasma leakage and abnormal haemostasis as its pathological hall marks. The WHO criteria for the clinical diagnosis of DHF requires the presence of acute and continuous fever of 2 to 7 days, haemorrhagic manifestations associated with thrombocytopenia (10x109 /L or less) and haemoconcentration (haematocrit >20% from baseline of patient or population of same age). Haemorrhagic manifestations could be mucosal and or skin or even a positive tourniquet test which is the commonest. DF can be without haemorrhage or have unusual haemorrhage 1.The main factor implicated in the development of DHF rather than the relatively innocuous DF in dengue infection is secondary dengue infection but other factors like viral virulence, and host characteristics are also important. Severe disease is the result of a complex interaction between the virus and the immune response evoked by the host with secondary infection 2. In both DF and DHF clinical bleeding is often mild and manifest as petechial
%U https://www.openaccesspub.org/jhor/article/130