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Dengue infection in hematologic-oncologic pediatric patients: aggravation of anemia and bleeding risk
Ampaiwan Chuansumrit1, Kanchana Tangnararatchakit, Nongnuch Sirachainan
1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. raajs@mahidol.ac.th
Insights
Pediatric dengue patients with hematologic-oncologic diseases face higher anemia and bleeding risks, especially those undergoing chemotherapy. Underlying conditions significantly increase dengue-related mortality risk.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Oncology
Background:
- Dengue infection poses significant risks to children, particularly those with pre-existing hematologic or oncologic conditions.
- Understanding these risks is crucial for effective patient management and improved outcomes.
Purpose of the Study:
- To investigate the specific risks of anemia and bleeding in pediatric patients with hematologic-oncologic diseases who contract dengue infection.
- To compare these risks between patients with and without underlying hematologic-oncologic conditions.
Main Methods:
- A study of 907 pediatric patients suspected of dengue infection, categorized into confirmed dengue and other febrile illnesses groups.
- Patients with underlying hematologic-oncologic diseases were further classified into subgroups based on anemia risk, bleeding risk, or combined risks.
Main Results:
- Patients with confirmed dengue and underlying hematologic-oncologic diseases exhibited distinct anemia and bleeding profiles.
- Subgroups experienced acute hemolysis, bleeding during febrile stages, and increased risks associated with chemotherapy.
- The case-fatality rate was significantly higher (3.64%) in dengue-infected patients with underlying diseases compared to those without (0.63%).
Conclusions:
- Pediatric dengue patients with hematologic-oncologic conditions face elevated risks of anemia and bleeding, necessitating tailored clinical approaches.
- Active chemotherapy treatment exacerbates anemia and bleeding risks, with risk decreasing after treatment discontinuation.
- Underlying hematologic-oncologic diseases are a critical factor associated with increased mortality in pediatric dengue infection.
Abstract:
We studied anemia and bleeding risk among hematologic-oncologic pediatric patients with dengue infection. A total of 907 patients suspected of having dengue infection were included in the study. They were categorized into 2 groups: 1) patients with confirmed dengue infection (n=843) and 2) patients with other febrile illnesses (n = 64). Both groups included patients with underlying hematologic-oncologic diseases (55 vs 14) and without underlying disease (788 vs 50). Patients with underlying diseases were divided into 3 subgroups by risk: Subgroup A, anemia risk, including patients with thalassemia and hemoglobinopathies (n = 39) and G6PD deficiency (n=6); Subgroup B, patients with bleeding risk, including hemophilia (n = 7), von Willebrand disease (n = 1) and thrombocytopenia (n = 4); and Subgroup C, patients with anemia and bleeding risk, including oncologic diseases (n =12). Acute hemolysis in Subgroup A started during the febrile stage and required packed red cell transfusions. Bleeding risk in Subgroup B started during the early febrile stage with vasculopathy and continued to the late febrile stage with thrombocytopenia. These patients required factor concentrate and platelet concentrate transfusions. Anemia and bleeding risk in Subgroup C was greater among patients undergoing chemotherapy than those who had discontinued treatment. The greater the length of time since discontinuation of treatment, the lower risk. The case-fatality rate among dengue infected patients with underlying disease (2/55 = 3.64%) was significantly higher than those without underlying disease 0.63% (5/788).
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