Study of Dengue Fever with Special Reference to Predictors of Spontaneous Bleeding in Dengue Infection

Background Dengue haemorrhagic fever (DHF), a potential lethal complication affects the Asian countries and has become a leading cause of hospital admissions and death among children. Dengue with its severe manifestations of DHF and dengue shock syndrome (DSS) has emerged as a major public health problem of international concern. Aims To identify the predictive factors for spontaneous bleeding manifestations in dengue illness in children. To determine the utility of haematological parameters as diagnostic markers of dengue haemorrhagic fever. Materials and Methods This is a prospective, cross-sectional study. Eighty patients (1–12 years) with proven diagnosis of dengue by NS1 were enrolled. Patients were divided into two groups: DHF group and DF group. A detailed history, clinical examination, with laboratory parameters was done in all patients. Data was analysed using SPSS version 7 by applying the appropriate tests. Results Dengue showed a seasonal trend, maximum number of cases (44 cases) were seen in September and October in 2012. Fever (100%), rash (62.5%), vomiting (60%), and abdominal pain (31.25%) were common features. Bleeding manifestations were petechiae and purpura 60.62%, melena was 40.63%, epistaxis was 15.63%, haematemesis was 3.12% and subconjuctival haemorrhage was 3.12%. Abdominal pain (31.25%), tender hepatomegaly (57.5%), and positive tourniquet test were significantly associated with spontaneous bleeding. Low platelet count was significantly associated with spontaneous bleeding but thrombocytopenia alone could not predict spontaneous bleeding. Conclusion Clinical criteria as such as abdominal pain, tender hepatomegaly, and positive tourniquet test along with the laboratory parameters such as haemoconcentration, low platelet count, abnormal serum levels of liver enzymes, and prolonged prothrombin time were significantly associated in predicting spontaneous bleeding and these predictors of spontaneous bleeding can help the clinician to anticipate the problem, prognosticate, decide the need of referral to higher centre for monitoring, managing and blood product transfusion when required, thus limiting the morbidity and mortality.