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Bleeding manifestations of dengue haemorrhagic fever in Malaysia
Abstract:
Analysis of the bleeding manifestations of 130 cases of dengue haemorrhagic fever admitted into the Children's ward of the General Hospital, Kuala Lumpur from May 1973 to September 1978 has been done. Petechial skin rash, epistaxis and gum bleeding were seen most commonly in mild and moderately severe cases. However, blood stained gastric aspirates, and severe haematemesis were seen in severe or very severe cases. Though with better vector control and preventive measures, a marked reduction in the incidence of the cases has been noted, severe cases were seen with symptoms of shock and gastrointestinal bleeding. These symptoms carried a bad prognosis. Among 15 children that died 10 had gastrointestinal bleeding and 2 had a disseminated intravascular coagulation defect. Lymphocytosis with atypical lymphocytes, low platelet count, low reticulocyte count and raised packed cell volume were the main haematological features seen in all these cases. All these features reverted to normal within a week. Mild evidence of disseminated intravascular coagulation was seen in a number of cases, but severe features were seen only in four. Two cases improved as a result of heparin therapy.
Insights
Dengue hemorrhagic fever in children often presents with bleeding. Severe cases show shock and gastrointestinal bleeding, indicating a poor prognosis, but some cases may improve with heparin therapy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Dengue hemorrhagic fever (DHF) is a significant pediatric concern.
- Bleeding manifestations are a hallmark of severe DHF.
- Understanding these manifestations is crucial for prognosis and management.
Purpose of the Study:
- To analyze the spectrum of bleeding symptoms in pediatric DHF cases.
- To correlate bleeding patterns with disease severity and outcomes.
- To identify key hematological features associated with DHF.
Main Methods:
- Retrospective analysis of 130 pediatric DHF cases admitted between May 1973 and September 1978.
- Clinical data collection focusing on bleeding manifestations and severity.
- Hematological parameters including platelet count, reticulocyte count, and packed cell volume were assessed.
Main Results:
- Petechial rash, epistaxis, and gum bleeding were common in milder cases.
- Severe gastrointestinal bleeding and hematemesis were observed in severe DHF.
- Hematological findings included lymphocytosis, atypical lymphocytes, low platelets, low reticulocytes, and elevated packed cell volume.
- Gastrointestinal bleeding was noted in 10 of 15 fatal cases.
- Disseminated intravascular coagulation (DIC) was present in severe forms, with two cases responding to heparin therapy.
Conclusions:
- Bleeding patterns in pediatric DHF vary with severity, with severe manifestations indicating a poor prognosis.
- Key hematological changes are indicative of DHF and typically normalize within a week.
- While DIC can occur, severe forms are less common, and heparin may be beneficial in select cases.