Abnormal hemostasis in dengue hemorrhagic fever

Area of Science:

• Hematology
• Infectious Diseases
• Pathophysiology

Background:

• Dengue Hemorrhagic Fever (DHF) is characterized by abnormal hemostasis.
• Understanding the specific hemostatic defects is crucial for managing DHF and Dengue Shock Syndrome (DSS).

Purpose of the Study:

• To elucidate the multifaceted hemostatic abnormalities in Dengue Hemorrhagic Fever.
• To detail the mechanisms underlying vasculopathy, platelet dysfunction, and coagulopathy in DHF.

Main Methods:

• Review of evidence supporting vasculopathy, including anaphylatoxin levels, tourniquet tests, and prostacyclin (PGI2) levels.
• Analysis of causes for thrombocytopenia (bone marrow issues, destruction, immune-mediated injury, viral effects).
• Assessment of platelet dysfunction (release of betathromboglobulin (BTG) and PF4, impaired aggregation).
• Examination of coagulopathy, including prothrombin complex deficiency and consumptive coagulopathy (Disseminated Intravascular Coagulation - DIC).

Main Results:

• Vasculopathy is evident from early febrile stages through shock, marked by increased anaphylatoxins and PGI2, and positive tourniquet tests.
• Thrombocytopenia results from bone marrow problems, peripheral destruction, immune attack, and direct viral impact on platelets.
• Platelet dysfunction includes increased release of mediators and impaired aggregation responses.
• Coagulopathy involves prothrombin complex deficiency from liver damage and consumptive coagulopathy, with DIC in severe Dengue Shock Syndrome (DSS).

Conclusions:

• Abnormal hemostasis in DHF is a complex interplay of vasculopathy, platelet abnormalities, and coagulopathy.
• These hemostatic defects significantly contribute to the pathogenesis and clinical manifestations of DHF and DSS.
• Further research into these mechanisms can guide therapeutic strategies for dengue.