Hemostatic changes in Vietnamese children with mild dengue correlate with the severity of vascular leakage rather than bleeding.
The mechanisms underlying the bleeding manifestations and coagulopathy associated with dengue remain unclear, in part because of the focus of much previous work on severe disease without an appropriate comparison group. We describe detailed clinical and laboratory profiles for a large group of children with dengue of all severities, and a group with similar non-dengue febrile illnesses, all followed prospectively from early presentation through to recovery. Among the dengue-infected patients but not the controls, thrombocytopenia, increased partial thromboplastin times and reduced fibrinogen concentrations were apparent from an early stage, and these abnormalities correlated strongly with the severity and timing of vascular leakage but not bleeding. There was little evidence of procoagulant activation. The findings do not support a primary diagnosis of disseminated intravascular coagulation to explain the intrinsic coagulopathy. An alternative biologically plausible hypothesis is discussed.
Wills
Bridget
B
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam. bwills@oucru.org
Tran
Van Ngoc
VN
Nguyen
Thi Hong Van
TH
Truong
Thi Thu Thuy
TT
Tran
Thi Nhu Thuy
TN
Nguyen
Minh Dung
MD
Tran
Vinh Diet
VD
Nguyen
Van Vinh Chau
VV
Dinh
The Trung
TT
Farrar
Jeremy
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D008297:Male; D013921:Thrombocytopenia; D014744:Vietnam / Q000453:epidemiology