Anemia: A Diagnostic Malady in Management of Dengue Patients
Keywords:
Dengue, Anemia, Hemoglobin variation, MCV, red cell indices
Abstract
Background: With the high prevalence of anemia and increasing incidence of dengue in developing countries like India, diagnosis of anemia in dengue patients needs to be stressed. There is higher hemoglobin and hematocrit as a result of plasma leakage in dengue, hence diagnosis and treatment of anemia may be missed. Methods: Hospital based retrospective study was done on 138 patients diagnosed with Dengue fever during the year 2017, in a tertiary care teaching hospital in Hyderabad. The CBC data was retrieved and statistical analysis was performed. Result: 60% of patients >5 yrs of age showed low Hb however hypochromia on smear was noted in 93.3% of cases. In patients aged 5-11yrs and 12-14 yrs, 31.4% and 14.3% respectively had low Hb, but hypochromia was noted in 48.6% and 57.1% .In non pregnant females, 68.4% showed low Hb while 55.3% cases showed Hypochromia. In males,25% of cases showed low Hb whereas 13.9% showed Hypochromia. An analysis of 36 in patents with >3 reports was done to demonstrate the variation in Hb,MCV and MCH during course of admission. There was wide variability in Hb concentration of same patient on CV above 1% in 91.7% of the cases. MCV and MCH had CV more than 1.1% and 0.5% in 25% and 69.4% of the cases respectively. Conclusion: MCV is a stable parameter which can be used to assess the morphological status of the RBC even in a background of heamoconcentration. Complication of volume overload needs to be avoided in an anemic patient suffering from dengue .The importance of inclusion of red cell indices especially MCV in CBC reports is stressed.References
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3. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV Anaemia in low-income and middle-income countries. Lancet 2011;378(9809):2123–35. doi:10.1016/S0140-6736(10)62304-5
4. Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/10665/259425/1/9789241513067-eng.pdf, accessed 15 January 2018).
5. National Health Policy 2017. New Delhi: Ministry of Health and Family Welfare, Government of India; 2017 (http://cdsco.nic.in/writereaddata/National-Health-Policy.pdf, accessed 15 January 2018).
6. WHO UNICEF and UNU Iron Deficiency Anaemia: Assessment, Prevention and Control, A Guide for Programme Managers, WHO, UNICEF, UNU, Geneva, Switzerland,2001, (http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en/index.html, accessed 22 oct 2019).
7. Martina BE, Koraka P, Osterhaus AD Dengue virus pathogenesis: an integrated view. Clin Microbiol Rev. 2009;22(4):564–581. doi: 10.1128/CMR.00035-09.
8. SurveySoftware-The survey system[Internet].Survey Software-Questionnire Software-Electronic Survey Software-The survey system;creative research systems;2012[cited 2019 Oct22].Available from: http://www.surveysystem.com/
9. Ganeshkumar P, Murhekar MV, Poornima V, Saravanakumar V, Sukumarn K Dengue infection in India: A systemic review and meta-analysis. PLOS Neglected Tropical Diseases 2018;12(7):e0006618.
10. Mogra G, Ghildiyal RG, Mohanlal S Classification and study of the clinico- hematological profile of patients with dengue fever in the pediatric age group. Int J Contemp Pediatr 2016;3:1405-10.
11. Chaloemwong J, Tantiworawit A, Rattanathammeethee T, Hantrakool S, Chaiadisakshopa C, Rattarittmrong E, Norasetthada L Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study. BMC Hematol 2018;18:20. doi: 10.1186/s12878-018-0116-1
12. Martina BE, Koraka P, Osterhaus AD Dengue virus pathogenesis: an integrated view. Clin Microbiol Rev. 2009;22(4):564–81.
13. Ralapanawa U, Alawattegama ATM, Gunrathne M, Tennakoon S, Kularatne SAM, Jayalath S Value of peripheral blood count for dengue severity prediction. BMC Res Notes 2018;11(1):400.
14. Ramandeep K, Babita, Promila S. Heamtological and Biochemical Changes in Dengue Fever, Int J Pharm Sci Inv.2014; 3 (5):01-05
15. Shamsunder Khatroth. A Study on Clinical and Hematological Profile of Dengue Fever in a Tertiary Care Hospital. IAIM 2017;4(8):96-102.
16. Meena KC, Jelia S, Meena S, Arif M, Ajmera D, Jatav VS A study of hematological profile in dengue fever at a tertiary care center, Kota Rajasthan. Int J Adv Med. 2016; 3(3):621-624.
17. Dongre T, Karmarkar P. Hematological Parameters and Its Utility in Dengue-A Prospestive Study. IOSR Journal of Dental and Medical Sciences, 2015;14(2):31-34
18. Mehta TK, Parul DS. Evaluation of Recent WHO Classification (2009) for Assessment of Dengue Disease Severity. Int.J Curr Microbiol App Sci 2015;4(9):755-765
19. Azin FR, Gonçalves RP, Pitombeira MH, Lima DM, Castelo Branco. Dengue: profile of hematological and biochemical dynamics. Rev Bras Hematol Hemoter. 2012;34(1):36-41
20. Sharma JB, Meenakshi S, Anemia in Pregnancy. JIMSA 2010;23(4):253-60
21. Scott BH, Lan N T, Myint TT, Shwe TN, Nisalak A, Kalyanarooj S, et al. Dengue Hemorrhagic Fever in Infants: Research Opportunities Ignored Emerging Infectious Diseases 2002;12(8):1474-79
22. Zhu Y, Tong L, Kaixiao N, Itsanun W, Peng S, Qingqing L, et al. Host serum iron modulates dengue virus acquisition by mosquitoes Nat Microbiol 2019; 1. doi: 10.1038/s41564-019-0555-x.
Published
2019-12-28
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