Disseminated intravascular coagulation in adult Dengue haemorrhagic fever: Report of three cases.

T Srichaikul, S Punyagupta, P Nitiyanant… - … Asian Journal of …, 1975 - cabdirect.org
T Srichaikul, S Punyagupta, P Nitiyanant, K Alkarawong
Southeast Asian Journal of Tropical Medicine and Public Health, 1975cabdirect.org
During the period 1968 to 1974, nine patients with serologically proven dengue
haemorrhagic fever (DHF) were seen at Ramathibodi Hospital, Bangkok. 3 patients showed
evidence of disseminated intravascular coagulation (DIC) and the paper reports clinical,
laboratory and pathological findings in these 3 patients.[Unfortunately no further details are
given about the other 6 patients.] In case 1 a Thai male, aged 15 years, was admitted
semicomatose, with undetectable blood pressure, epistaxis, and diffuse purpura. Later …
Abstract
During the period 1968 to 1974, nine patients with serologically proven dengue haemorrhagic fever (DHF) were seen at Ramathibodi Hospital, Bangkok. 3 patients showed evidence of disseminated intravascular coagulation (DIC) and the paper reports clinical, laboratory and pathological findings in these 3 patients.[Unfortunately no further details are given about the other 6 patients.] In case 1 a Thai male, aged 15 years, was admitted semicomatose, with undetectable blood pressure, epistaxis, and diffuse purpura. Later cardiac arrest, haematemesis, melaena, and oliguria were observed. Treatment included transfusions of blood, fibrinogen and platelet concentrates, dexamethasone, heparin, dextran, endotracheal intubation, frusemide and mannitol but he died 9 hours after admission. Necropsy showed haemorrhage in all organs and [not unexpectedly] fibrin thrombi in the kidneys and lungs. The second patient showed similar clinical features but temporarily improved after similar treatment. Heparin and dexamethasone were then. stopped because of the fear of iatrogenic bleeding. The pericardial rub continued and the patient died 4 days after admission. Necropsy findings were similar to those in the first case. In the third case, a male aged 16 years was admitted complaining of fever for 6 days. He was acutely ill, disorientated, with blood pressure of 100/80 mmHg. Generalized petechiae were observed and during the admission examination he had epistaxis, haematemesis and melaena. Treatment was started with dextran and dexamethasone but on the evening of the second day in hospital, shock developed and heparin was started. Thereafter the patient gradually improved and was discharged on the tenth day after admission with complete recovery. Haematological and other laboratory findings in the 3 patients are detailed in a table. The role of DIC in DHF is discussed and the authors conclude that treatment with heparin should be considered but a controlled study would clarify the matter. H. Allst air Reid.
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