A prospective clinical study of incidence of hepatorenal and hematological complications in dengue fever and management of symptomatic bleed in bundelkhand region of Northern India with fresh whole blood

摘要

Dengue is the most rapidly spreading mosquito-borne viral disease in the world. Besides bleeding, cases of hepatic and renal dysfunction in dengue fever are increasing in incidence. In management of hemorrhagic complications, fresh whole blood is far superior to platelet transfusion and fresh frozen plasma. This work is aimed at studying the incidence of hepatorenal and haematological complications and the management of symptomatic bleed with fresh whole blood in dengue fever. A prospective design was carried out with 62 Dengue positive patients either admitted in wards or attending Medicine Out Patient Department of MLB Medical College Jhansi were recruited in this study between 1st January 2010 and 31st December 2010. Patients were assessed for hepatorenal and haematological complications as well as management of symptomatic bleed were also studied. Incidence of jaundice in dengue fever was 15% of which one third cases were of direct hyperbilirubinemia and two third those of indirect hyperbilirubinemia. Serum glutamate pyruvate transaminase (SGPT) was raised in 68% patients while serum glutamate oxaloacetate transaminase (SGOT) was high in 71% patients. Incidence of renal failure in dengue fever was 16% (as per glomerular filtration rate (GRF) levels calculated by modified diet in renal disease formula). The leucopenia was seen in 31% and leucocytosis in 17%. Although the incidence of thrombocytopenia was observed in 92% while bleeding was seen in 32% cases only. All the cases were managed with fresh whole blood transfusion and 100% successful outcome. Incidences of hepatic and renal complications were present in 85 and 39% cases, respectively. Bleeding manifestations were seen in 32% cases, which do not correspond always to platelet counts and respond to fresh whole blood transfusion excellently.