Management of Symptomatic Thrombocytopenia Associated with Dengue Haemorrhagic Fever

Abstract

Introduction: Immune – mediated destruction of platelets is thought to be the mechanism of thrombocytopenia seen after the viraemic phase of dengue haemorrhagic fever (DHF). Immuno – suppressants such as steroids, immune globulin and Anti D immuneglobulin are effective in the treatment of this type of immune thrombocytopenic purpura.
Objective: To evaluate the efficacy of oral Prednisolone in the rate of resolution of thrombocytopenia and monitoring of complications in patients recovering from Dengue haemorrhagic fever.
Method: A controlled study was carried out on diagnosed cases Dengue haemorrhagic patients presenting with sever throm-bocytopenia and symptoms like confluent ecchymosis, epistaxis and purpuric rashes. In study was conducted in Ittefaq hos-pital (trust) Lahore, during the period of October to December 2008. Treatment group received steroids in two forms i.e. 1st line therapy prednisolone (1 mg / kg) orally or as 2nd line therapy of initial I/V high dose (prednisolone) in pulse doses i.e. 40 mg / bd for four days and later oral prednisolone as in 1st line therapy with omeprazole 20 mg / bd in addition to standard treatment. Control group received standard supportive care only.
Results: A total of 341 suspected patients were admitted in hospital. Serological diagnosis was confirmed in 166 patients. CBC revealed platelet count ≤ 100 x 109 / l in 106 patients. A group of symptomatic febrile patients have platelet count < 20 x 109 / l was selected for therapeutic intervention. 1st line therapy (oral prednisolone was stated in 43 patients. In Fourteen patients 2nd line therapy (high dose dexamethasone pulse) therapy was instituted. Seven of them attained complete response whereas two patients achieved partial response. Four patients were shifted to Anti D therapy. Three deaths occurred during our study. Rest of all the patients improved and were discharged in due course of time.
Conclusion: This small scale preliminary study shows promising results in reducing the morbidity of patients in a relatively serious stage but large scale double blinded randomized controlled studies are needed before making recommendations on use of steroids in symptomatic thrombocytopenic patients with dengue haemorrhagic fever.