Thromboelastographic analysis of hemostatic abnormalities in dengue patients admitted in a multidisciplinary intensive care unit: A cross-sectional study

Abstract

Background:Dengue fever is an important tropical infection causing significant mortality. The pathophysiology of hematological abnormalities in dengue remains poorly studied. In this study, we analyzed the hematological abnormalities by thromboelastography (TEG).Methods:This cross-sectional study evaluated complicated dengue patients with TEG. Thromboelastographic variables were categorized into six patterns: factor deficiency, platelet dysfunction, enzymatic hypercoagulability, combined enzymatic and platelet hypercoagulability, primary fibrinolysis, and secondary hyperfibrinolysis.Results:Twenty-five patients were analyzed for coagulation abnormalities by TEG. Coagulation factor deficiency pattern was noted in 11 patients (44%) whereas 3 patients (12%) were found to have low fibrinogen level pattern. Low platelet function was noted in 4 (16%) patients. Enzymatic hypercoagulability and combined enzymatic and platelet hypercoagulability were noted in one patient each (4.5%). Secondary fibrinolysis was noted in 1 patient (5%) and primary fibrinolysis in 3 (15.8%) patients. Factor deficiency pattern and low fibrinogen pattern were not significantly associated with hepatitis (P > 0.05). Activated partial thromboplastin time (aPTT) was not found to be significantly associated with factor deficiency pattern (P = 0.10) and low fibrinogen pattern (P = 0.20). Platelet count was not found to be significantly associated with platelet function (P = 0.54).Conclusion:Factor deficiency pattern was the major abnormality noted in dengue patients followed by platelet dysfunction and primary fibrinolysis. Platelet count did not show significant association with platelet function. aPTT did not show significant association with factor deficiency and low fibrinogen patterns. Factor deficiency pattern and low fibrinogen pattern did not show significant association with hepatitis.

Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever

“… 5 Thromboelastography (TEG) analyses of dengue patients have revealed coagulation factor deficiency as the major abnormality followed by platelet dysfunction and primary fibrinolysis. 6 Our obstetric setup did not have TEG facility to validate these findings.…”

Hypocoagulability in severe yellow fever infection is associated with bleeding: results from a cohort study

“…Two studies have investigated the use of TEG/ROTEM in dengue [ 27 , 28 ]. In patients with dengue fever infection and thrombocytopenia, Piza et al.…”

“…[ 27 ] found normal routine coagulation tests but hypocoagulability by ROTEM in about 70% and 55% of patients when tested with intrinsic coagulation pathway assessment (INTEM) and extrinsic coagulation pathway assessment (EXTEM), respectively. Others evaluated the use of TEG or ROTEM to investigate hemostasis in patients with ALF [ 9 ], stable cirrhosis [ 9 , 28 ], and patients with acute decompensation of cirrhosis or acute-on-chronic liver failure [ 8 , [29] , [30] , [31] ]. Whereas TEG parameters in these patients are generally within normal limits, ROTEM suggested a hypocoagulable state.…”

Thromboelastographic analysis of hemostatic abnormalities in dengue patients admitted in a multidisciplinary intensive care unit: A cross-sectional study

“…published in April 2018 issue of your journal. [ 1 ] The authors have recorded and provided vital information on a relatively unexplored area and rightly pointed out that thromboelastography (TEG) may be helpful in understanding the pathophysiology of hemostatic abnormalities in patients with dengue.…”