Thrombocytopenia in Dengue illness: Destruction, Suppression and Composite platelet index: A Retrospective study
Keywords:
Composite platelet index, Dengue fever, Mean platelet volume, Platelet distribution width, Platelet indices, Platelet large cell ratio
Abstract
Background: Dengue is a common viral illness which can be fatal. Thrombocytopenia is the common hematological abnormality which can result in catastrophic bleeding. The present study attempts to look at the magnitude of different mechanisms causing thrombocytopenia with the help of platelet indices.Methods: This was a retrospective study undertaken in a tertiary care center in south India. Of all the adult patients admitted for the treatment of Dengue illness between June 2013 to May 2014, Platelet indices such as Mean platelet volume (MPV) and Platelet large cell ratio (P – LCR) of 98 patients were collected and analyzed. Proportion of patients with increased MPV (> 11.5) and P – LCR (>37) was then computed.Result: Among the dengue patients, 56.1% had raised MPV (>11.5) and 59.2% had raised Platelet large cell ratio (>37). This suggested that more than half of the patients had platelet destruction and the rest had bone marrow suppression. There was significant increase in Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and platelet Large Cell Ratio (LCR) in Dengue patients compared to the controls.We devised a composite platelet index (CPLI) by multiplying platelet count with MPV which we believe could be a better indicator of bleeding than either alone. In our study we found the median composite platelet index in dengue patients was 5.9 compared to 27. 2 in the controls.Conclusion: Peripheral destruction and bone marrow suppression is seen in equal proportion of patients with dengue illness.References
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2. Bashir AB, Saeed OK, Mohammed BA, Ageep AK. Role of Platelet Indices in Patients with Dengue Infection in Red Sea State, Sudan. International Journal of Science and Research. 2015;4:1573-6.
3. Elsewefy DA, Farweez BA, Ibrahim RR. Platelet indices: consideration in thrombocytopenia. Egyptian Journal of Haematol. 2014;39:134-8.
4.Jayashree K, Manasa GC, Pallavi P, Manjunath GV. Evaluation of Platelets as Predictive Parameters in Dengue Fever. Indian J Hematol Blood Transfus. 2011;27:127-30.
5.Khaleed JK, Abeer Anwer AA, Maysem Alwash AA. Platelet indices and their relations to platelet count in hypoproductive and hyper-destructive Thrombocytopenia. Karbala J. Med. 2014;7:1952-8.
6.Thein T-L, Lye DC, Leo Y-S, Wong JGX, Hao Y, Wilder-Smith A. Severe Neutropenia in Dengue Patients: Prevalence and Significance. Am J Trop Med Hyg. 2014;90:984-7
7.Narayanan M, Aravind MA, Ambikapathy P, Prema, Jeyapaul MP. Dengue Fever – Clinical and Laboratory Parameters Associated with Complications. Dengue Bulletin. 2003;27:108-15.
8.Santosh ST, Chincholkar VV, Kulkarni DM, Nilekar SL , Ovhal RS, Halgarkar CS. A study of NS1 antigen and platelet count for early diagnosis of dengue infection. Int.J. Curr. Microbiol. App.Sci. 2013;2:40-4.
9.Saito M, Oishi K, Inoue S, Dimaano EM, Alera MTP, Robles AMP, et al. Association of increased platelet-associated immunoglobulins with thrombocytopenia and the severity of disease in secondary dengue virus infections. Clin Exp Immunol. 2004;138:299-303.
10.Bashir AB, Mohammed BA, Saeed OK, Ageep AK. Thrombocytopenia and bleeding manifestations among patients with dengue virus infection in Port Sudan,Red Sea State of Sudan. J infect Dis.Immun. 2013;7:7-13.
11.Murgue B, Cassar O, Guigon M, Chungue E. Dengue virus inhibits human hematopoietic progenitor growth in vitro. J Infect Dis. 1997;175:1497-501.
12.Mitrakul C. Bleeding problem in dengue hemorrhagic fever: platelets and coagulation changes. Southeast Asian J Trop Med Public health. 1987;18:407-12.
13.Dinesh N, Patil VD. Persistent Thrombocytopenia after Dengue Hemorrhagic Fever Indian Pediatr. 2006;43:1010-11.
14.Sellahewa KH, Samaraweera N, Thusita KP, Fernando JL. Is fresh frozen plasma effective for thrombocytopenia in adults with dengue fever? A prospective randomised double blind controlled study. Ceylon Med J. 2008;53:36-40.
15.Murgue B, Cassar O, Guigon M, Chungue EJ. Dengue virus inhibits human hematopoietic progenitor growth in vitro. Infect Dis. 1997;175:1497-501.
16.Clark KB, Noisakran S, Onlamoon N, Hsiao HM, Roback J, Villinger, F. et al. Multiploid CD61+ Cells Are the Pre-Dominant Cell Lineage Infected during Acute Dengue Virus Infection in Bone Marrow. PLoS ONE. 2012;7:e52902.
17.Noisakran S, Onlamoon N, Pattanapanyasat K, et al. Role of CD61+ cells in thrombocytopenia of dengue patients. Int J Hematol. 2012;96:600-10.
18.La Russa VF1, Innis BL. Mechanisms of dengue virus-induced bone marrow suppression. Baillieres Clin Haematol. 1995;8:249-70.
19.Rajapakse S, Rodrigo C, Maduranga S, Rajapakse AC. Corticosteroids in the treatment of dengue shock syndrome. Infect and Drug Resist. 2014;7:137-43.
20.Simon AY, Sutherland MR, Pryzdial ELG. Dengue virus binding and replication by platelets. Blood. 2015;126:378-85.
21.Sharma S, Sharma SK, Mohan A, Wadhwa J, Dar L, Thulkar S, Pande JN. Clinical profile of dengue hemorrhagic fever in adults during 1996 -outbreak in Delhi, India. Dengue Bulletin. 1998; 22:20-7.
Published
2016-11-08
Section
Original Article
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