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Study of haematological, biochemical profile and clinical presentation in

dengue positive patients: 82 cases

Article in International Journal of Research in Medical Sciences · May 2018

DOI: 10.18203/2320-6012.ijrms20182296

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International Journal of Research in Medical Sciences
Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182296
Original Research Article

Study of haematological, biochemical profile and clinical presentation in

dengue positive patients: 82 cases
Mubin I. Patel1*, Abhishek Patel2, Avani Patel1, Sharmistha Patel1, Suresh Padsala1

1
Department of Pathology, Government Medical College, Majura Gate, Surat, Gujarat, India
2
Department of Ophthalmology, SMIMER Medical College, Sahara Gate, Surat, Gujarat, India

Received: 02 April 2018

Accepted: 27 April 2018

*Correspondence:
Dr. Mubin I. Patel,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Dengue Fever (DF) is a self-limiting disease caused by arbovirus and transmitted by Aedes mosquitoes
(Aedes aegypti and Aedes albopictus). It is one of the 17 neglected tropical diseases by WHO. Diagnosis of dengue
depends mainly on the detection of IgM and IgG antibody, and NS1 antigen.
Methods: The study was carried out in Department of Pathology, affiliated with a government hospital. It includes 82
dengue patients, admitted from August 2015 to August 2016. Haematological, biochemical profile, clinical signs and
symptoms were recorded. The Tourniquet test was performed in all the patients on admission. Grading of dengue:
DF/DHFI/DHFII/DHFIII/DHFIV. Grade III and IV were collectively called as Dengue Shock Syndrome.
Results: Total 82 Dengue positive cases were studied, 52 (63%) were males and 30 (37%) were females. 24 (29%)
patients were recorded in September 22 (27%) in October 19 (23%) in August. 12 (14.60%) had positive tourniquet
test. Thrombocytopenia was present in 86.5 % patients. Majority cases were of classical dengue fever 51 (62.20%), 14
(17.07%) were of DHF I, 12 (14.63%) were of DHF II, 3 (3.66%) were of DHF III and 2 (2.44%) were of DHF IV.
Conclusions: It is very important to correlate clinical examination with haematological and biochemical profile in
dengue patients. Hematocrit value, leucopenia, thrombocytopenia, raised liver enzymes is very important to monitor
dengue cases in their initial stages and thus facilitate early treatment. This would minimize morbidity and mortality
arising out of serious complications of dengue fever.

Keywords: Dengue, DHF, Grading, DSS, Vector borne disease

INTRODUCTION mismanagement, increased distribution and densities of

vector mosquitoes, lack of effective mosquito control has
Dengue is a self-limiting acute mosquito transmitted increased movement and spread of dengue viruses and
disease characterized by fever, headache, muscle and development of hyper-endemicity.1 Dengue has been
joint pains, rash, nausea and vomiting. Dengue fever identified as one of the 17 neglected tropical diseases by
(DF) is caused by an arbovirus and spread by Aedes WHO (World Health Organization) as mentioned in their
mosquitoes. Some infections result in Dengue first report on neglected tropical diseases (2010). Of the
Hemorrhagic Fever (DHF) and in its severe form Dengue 11 countries of SEAR, 10 countries including India are
Shock Syndrome (DSS). Over the past two decades, there endemic for dengue. The disease has a seasonal pattern
has been global increase in the frequency of DF, DHF and the cases peak after the monsoons.2 There are 3
and its epidemics. Various factors responsible for the epidemiological factors: the host (man and mosquito),
resurgence of dengue epidemic are: human population The agent (virus), The environment (abiotic and biotic
growth, un-planned and un-controlled urbanization, factors) agent for dengue viruses belong to the genus
inadequate waste management, water supply Flavivirus. The virion comprises a spherical particle, 40-

International Journal of Research in Medical Sciences | June 2018 | Vol 6 | Issue 6 Page 2099
Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105

50 nm in diameter, with a lipopolysaccharide envelope. endothelium, platelets and various organs leading to
The positive single-strand RNA genome, which is vasculopathy and coagulopathy responsible for the
approximately 11 kb in length, has a single open reading development of haemorrhage and shock.5 Virus antibody
frame that encodes three structural proteins: Capsid (C), complexes have been detected on platelet surface of DHF
Membrane (M) glycoproteins, Envelope (E) patients suggesting a role for immune mediated
glycoproteins, seven non-structural proteins (NS1, NS2A, destruction of platelet. The release of high levels of
NS2B, NS3, NS4A, NS4B and NS5). There are four platelet activating factor by monocytes may induce
serotypes of the Dengue virus referred to as: DV-1, DV- platelet consumption and augment adhesiveness of
2, DV-3, DV-4.1-3 Dengue viruses are transmitted from an vascular endothelial cells resulting in thrombocytopenia.4
infected person to others by the bite of the female The presence of IgM antibodies in the sera of DHF cases
mosquito (Vector). cross react with platelets. These autoantibodies are
involved in pathogenesis of dengue.6 Leucopenia in
In India, Aedes aegypti and Aedes albopictus are the dengue fever may be caused by virus-induced destruction
main vectors. Other species like Aedes polynesiensis and or inhibition of myeloid progenitor cells.7 There is an
Aedes nevius have also been incriminated as secondary increase in aminotransferases, mainly AST has been
vectors in some countries.4 Aedes aegypti is a primary associated with disease severity and serves as an early
vector of viral diseases such as the dengue fever, indicator of dengue infection.8 AST and ALT were found
chikungunya viruses and yellow fever. Aedes albopictus to be increased 5-10 times in dengue fever due to liver
is also called the Asian tiger mosquito and is most well- parenchymal damage caused by the virus.9,10 Criteria for
known for transmitting dengue and chikungunya viruses, grading of dengue-DF/DHF/DSS. DF-Fever of 2-7 days
west Nile, Eastern equine encephalitis, Japanese with two or more of following: headache, retro-orbital
encephalitis. Environmental factor- Aedes Aegypti breeds pain, myalgia, arthralgia with or without leukopenia,
almost entirely in domestic man-made water receptacles thrombocytopenia and no evidence of plasma leakage.
found in and around households water storage containers, DHFI-above criteria plus positive tourniquet test and
water reservoirs, overhead tanks, desert coolers, tyres, evidence of plasma leakage. Thrombocytopenia with
coconut shells, unused grinding stones etc. Natural larval platelet count less than 100000/cumm and HCT rise more
habitats include tree holes, latex collecting cups in rubber than 20 % over baseline. DHFII- above criteria plus some
plantations, bamboo stumps etc. evidence of spontaneous bleeding in skin or other organs
(Black tarry stool, epistaxis, gum bleeds) and abdominal
Host factor- The dengue virus infects humans and several pain. Thrombocytopenia with platelet count less than
species of lower primates. Travel to dengue endemic 100000/cumm and HCT rise more than 20 % over
areas is a most important risk factor. The virus is baseline. DHFIII (DSS)-above criteria plus circulatory
transmitted when the infected female mosquito bites and failure (weak pulse, narrow pulse pressure <20mmHg,
injects its saliva into the wound of the person bitten. Hypotension, cold clammy skin, restlessness).
Dengue transmission can also occur through blood Thrombocytopenia with platelet count less than
transfusion, organ transplantation, congenital dengue 100000/cumm and HCT rise more than 20% over
infections in neonates born to infected mothers.4 Primary baseline. DHFIV (DSS)-Profound shock with
infection is infection caused by any serotype in non- undetectable blood pressure or pulse. Thrombocytopenia
immune individual. Secondary infection is heterotypic with platelet count less than 100000/cumm and HCT rise
infection in a monotypic immune individual. more than 20% over baseline. Expanded dengue
syndrome (EDS)-Mild or Severe organ involvement may
Primary infection is usually benign in nature, however be found in DF/DHF, the illness commonly begins
secondary infection with a different serotype or multiple abruptly with high fever accompanied by facial flushing
infections with different serotypes may cause severe and headache. Anorexia, vomiting, epigastric discomfort,
infection that can be classified as either dengue tenderness at right costal margin and generalized
haemorrhagic fever (DHF) or dengue shock syndrome abdominal pain are common.4 A positive tourniquet test
(DSS). Primary infections are characterized by an is the most common hemorrhagic phenomenon. Lab
increase in dengue- specific IgM antibodies four to five diagnosis of dengue.
days after the onset of fever and by an increase in IgG
antibodies only after the onset of fever and by an increase Immunological response based tests: IgM and IgG
in IgG antibodies only after seven to ten days. IgM antibody assays. IgM antibodies are detectable by days 3-
antibodies are detectable for three to six months, whereas 5 after the onset of illness, rise quickly by about two
IgG antibodies remain detectable for life. In secondary weeks and decline to undetectable levels after 2-3
infections, the level of IgM antibodies is lower than in months. IgG antibodies are detectable at low level by the
primary infections, whereas levels of IgG antibodies rise end of the first week, increase subsequently and remain
rapidly in secondary infections, even during the acute for a longer period. Because of the late appearance of
phase, thus the presence of high titers of IgG early in the IgM antibody i.e. after five days of onset of fever,
course of the disease is a criterion for secondary serological tests based on this antibody done during the
infection. Cells of the monocyte-macrophage lineage are first five days of clinical illness are usually negative.
the major sites of viral replication. They target vascular During the secondary dengue infection (when the host

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Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105

has previously been infected by dengue virus), antibody disease and can be detected in both patients with primary
titres rise rapidly. IgG antibodies are detectable at high and secondary dengue infections for up to six days after
levels, even in the initial phase and persist from several the onset of the illness.11
months to a lifelong period. IgM antibody levels are
significantly lower in secondary infection cases.11 Viral nucleic acid detection: Dengue viral genome which
consists of RNA can be detected by reverse transcriptase
Isolation of Dengue Virus: Specimens include serum, polymerase chain reaction (RTPCR) assay and real time
plasma or washed buffy coat from the patient, autopsy RT-PCR. They offer better specificity and sensitivity
tissues from fatal cases, especially liver, spleen, lymph compare to virus isolation with a much more rapid
nodes and thymus and mosquitoes collected in nature. turnaround time.
Isolation of the virus takes 7-10 days, hence it may not be
very useful for starting the management of patients with Management of dengue: A full blood count of the patient
DF/DHF.4 should be done at the first visit. A rapidly decreasing
platelet count in parallel with a rising haematocrit
Serological tests: Haemagglutination-Inhibition (HI), compared to the baseline is suggestive of progress to the
Complement Fixation (CF), Neutralization test (NT), IgM plasma leakage/critical phase of the disease.12
capture ELISA (MAC-ELISA) and Indirect IgG ELISA. Management of dengue fever is symptomatic and
MAC-ELISA has become widely used test in the past few supportive. Bed rest is advisable during the acute phase.
years. It is a simple, rapid test. It is based on detection of Antipyretics may be used to lower the body temperature.
the dengue-specific IgM antibodies in the test serum. It Aspirin/NSAIDS like Ibuprofen, etc should be avoided
has become an invaluable tool for surveillance of since it may cause gastritis, vomiting, acidosis, platelet
Dengue. It is especially useful for hospitalized patients dysfunction and severe bleeding. Paracetamol is
who are generally admitted late in the illness after preferable. Oral fluid and electrolyte therapy is
detectable IgM is already present in the blood. recommended for patients with excessive sweating or
vomiting. Intravenous fluid should be administered if the
Haematological tests: The white blood cell (WBC) count patient is vomiting persistently or refusing to feed.
may be normal or with predominant neutrophils in the Haematocrit should be determined daily especially from
early febrile phase. Initial leucopenia and leukocyte count the third day until the temperature remains normal for
returning to normal by ninth to tenth day after therapy in one or two days. DHF I and II- Any person who has
most of the cases. The platelet counts are normal during dengue fever with thrombocytopenia, high
the early febrile phase. According to WHO-2009, haemoconcentration and presents with abdominal pain,
thrombocytopenia is seen on 3 to 7 day. The haematocrit black tarry stools, epistaxis, bleeding from the gums etc.
is normal in the early febrile phase. A slight increase may needs to be hospitalized. Prophylactic platelet can be
be due to high fever, anorexia and vomiting. A sudden given if platelet count decreased below <10,000/cmm.
rise in haematocrit is observed simultaneously or shortly Dengue patients should preferably receive single donor
after the drop in platelet count. Haemoconcentration or apheresis platelets (SDAP) as compared to random donor
rising haematocrit by 20% from the baseline, e.g. from platelets (RDP) to lower the risk of alloimmunization.13
haematocrit of 35% to ≥42% is objective evidence of Complication can occur like metabolic acidosis and
leakage of plasma. A rise in haematocrit occurs in all severe bleeding due to DIC and multi-organ failure.
DHF cases, particularly in shock cases. Metabolic abnormalities are frequently found as
Haemoconcentration with haematocrit increases by 20% hypoglycemia, hyponatremia, hypocalcemia and
or more is objective evidence of plasma leakage. Other occasionally, hyperglycemia.
common findings are hypoproteinemia/albuminaemia (as
a consequence of plasma leakage), hyponatremia and METHODS
mildly elevated AST (≤200U/L) with the ratio of AST:
ALT >2. In most cases, assays of coagulation and The present study was conducted in the Department of
fibrinolytic factors show reductions in fibrinogen, Pathology, affiliated with a Tertiary care hospital. It
prothrombin, factor VIII, factor XII and antithrombin III. includes 82 patients with dengue fever admitted in
medicine wards from August 2015 to August 2016. All
Detection of antigens: The NS1 gene product is a patients were suffering from dengue, confirmed by
glycoprotein produced by all flaviviruses and is essential ELISA-IgM/NS1/PCR test. Haematological profile,
for replication and viability of the virus. NS1 antigen biochemical profile and clinical signs and symptoms
appears as early as Day1 after the onset of the fever and from the day of admission are collected. Samples for
declines to undetectable levels by 5-6 days. Hence, tests hematological data were analyzed using micros 60, three-
based on this antigen can be used for early diagnosis. part fully automated haematology analyzer. Fully
ELISA and dot blot assays directed against the automated clinical chemistry analyser-erba XL-640 was
envelop/membrane (EM) antigens and nonstructural used for the biochemistry. Tourniquet test: The tourniquet
protein 1 (NS1) demonstrated that this antigen is present test (TT) is a physical examination technique that can
in high concentrations in the sera of the dengue virus- identify and stratify dengue disease. The resulting
infected patients during the early clinical phase of the petechiae (cutaneous pinpoint, non-raised, purplish-red

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Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105

spots) can be found in patients with and DHF. The TT is August (Table 3) No patients were observed in month of
performed by inflating a blood pressure cuff midway March, April, May and June. All the 82 patients
between the systolic and diastolic blood pressure on a presented with fever 82 (100%). Out of 82 patients, 12
person’s upper arm. After five minutes, if the number of (14.60%) had positive tourniquet test, 30 (36.60%) had
petechiae counted in an area exceeds a certain number pleural effusion, 26 (31.70%) had ascities, 11 (13.40%)
(20 petechiae in a one square inch area), then the test had petechial spots, 24 (29.30%) had hepatomegaly, 8
result is considered positive. Tourniquet test was carried (9.80%) had splenomegaly and 3 (3.60%) had sub-
out in all patients on admission. conjunctival haemorrhage (Table 4).

All cases were graded according to severity criteria based Table 3: Distribution of cases according to calendar
on the technical guidelines from the WHO: month (Season).
DF/DHFI/DHFII/DHFIII/DHFIV. Grade III and IV are
collectively called as Dengue Shock Syndrome. Data of Month Cases (no.) Cases (%)
complete blood count like haemoglobin, HCT, platelet August 19 23.15 %
and WBC count were collected. These data were September 24 29.27 %
collected on 1st, 3rd and 7th days of the admission and October 22 26.83 %
values were compared between different days. Normal November 8 9.77 %
reference ranges of parameters are: Platelet: 1.5- December 3 3.66 %
4.0lac/cmm, WBC: 4000-11000/cmm, HCT: 40-54%,
January 2 2.44 %
Hb:13.5-17gm %, WBC count <4000/cmm is considered
February 1 1.22 %
leucopenia, platelet count <150000/cmm was considered
thrombocytopenia. Level of transaminase-Aspartate July 3 3.66 %
Transaminase (AST) and Alanine Transaminase (ALT) Total 82 100 %
were noted. AST and ALT >45 U/L were considered
elevated. Clinical symptoms and signs like fever, Table 4: Distribution of cases according to symptoms.
headache, myalgia, arthralgia, rash, vomiting, diarrhea,
altered consciousness, breathlessness, ascites, Symptoms Cases (no.) Cases (%)
hepatomegaly, pleural effusion, splenomegaly, petechial Fever 82 100 %
and sub-conjunctival haemorrhage were recorded. Arthralgia 72 87 %
Myalgia 49 59 %
RESULTS Headache 61 74.4 %
Abdominal pain 29 35.4 %
In the present study, total 82 Dengue positive cases were Rash 13 15.6 %
studied, 52 (63%) were males and 30 (37%) were females Vomiting 15 18.3 %
(Table 2). The male: female ratio was 1.7:1. Out of 82
Diarrhoea 11 13.4 %
patients, majority i.e. 31 (37.8 %) were in age group of
Melena 8 9.6 %
15 to 25 years followed by 29 (35.38%) in the age group
of 26 to 35 years (Table 1). Altered sensorium 4 4.8 %
Breathlessness 3 3.6 %
Table 1: Distribution of cases according to age.
Table 5: Distribution of patients according to platelet
Age (years) Cases (no.) Cases (%) count.
15-25 31 37.8 %
26-35 29 35.38 % Platelet count (Range) Cases (no.) Cases (%)
36-45 13 15.82 % 20000-39000/ul 17 20.7 %
46-55 5 6.11 % 40000-79000/ul 35 42.68 %
56-65 3 3.67 % 80000-99000/ul 19 23.1 %
66-75 1 1.22 % >100000/ul 11 13.4 %
Total 82 100 % Total 82 100 %

Table 2: Distribution of cases according to sex. Table 6: Distribution of patients according to WBC
count.
Gender Cases (no.) Cases (%)
Range of WBC count Cases (no.) Cases (%)
Male 52 63.4 %
1100-2000 6 7.3 %
Female 30 36.6 %
2100-3000 26 31.7 %
Total 82 100 %
3100-4000 21 25.6 %
>4000 29 35.3 %
In present study, 24 (29%) were observed in September
22 (27%) observed in October 19 (23%) observed in

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Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105

In present study out of 82 patients, thrombocytopenia was observed in 86.5% of cases which is supported by
present in 86.5% of patients and majority i.e. 35 Priyanka et al and Avarebeel et al, who also observed
(42.68%) had platelet count between 40000-79000/cmm 59% and 99%.22,23 In present study, mean value of
(Table 5). Mean value of Hemoglobin on 1st day was platelet count on 1st day was (87207.31), mean value of
12.8% and it was decreased on 3rd and 7th day platelet count decreased on 3rd day (74902.434) and again
respectively (12.5% and 12.2%). Majority of the patients on 7th day mean value of platelet count was increased
have WBC count more than 4000/cmm (Table 6). (111585.37). There was a significant difference between
Majority cases were of classical dengue fever 51 platelet counts of day1, day 3 and day 7 according to
(62.20%), 14 (17.07%) were of DHF I, 12 (14.63%) were mean and standard deviation (p value<0.05). It is
of DHF II, 3 (3.66%) were of DHF III and only 2 supported by comprehensive guidelines for control and
(2.44%) were of DHF IV. Out of 82, 2 patients of DHF prevention of DF and DHF (revised and expanded edition
IV died due to ARDS and shock. One patient had 60% WHO 2011) which states that thrombocytopenia is
HCT, 2800/cmm WBC count, 79000/cmm platelet count observed between day three and ten.11
and had fever, vomiting, melena, pleural effusion and
headache. Other patient had 58.4 % HCT, 7600/cmm In present study, leucopenia was observed in 64.3%
WBC count, 2300/cmm platelet count and had similar patients. Priyanka et al, and Avarebeel et al, observed
complain with rash. leucopenia in 44% and 41.04% respectively.22,23
Leucopenia is observed when infection is caused by more
DISCUSSION virulent strain. In present study, mean value of WBC
count on 1st day was (5021.95). It decreased on 3rd day
Due to changing climate, urbanization, poor living (4260.976) and again increased on 7th day (4312.20)
conditions and inadequate waste management, vector There was a significant difference between WBC counts
born diseases like dengue fever are becoming more of 1stand 3rd day and 1stand 7th day according to mean and
common. Prevelance of aedes albopictus and aedes standard deviation (p<0.05).
aegypti together with circulation of dengue virus of more
than one type in any particular area tends to be associated It is supported by Gajera et al, study who also observed
with outbreaks of DHF/DSS.12 As most of the patients initial leucopenia and then leukocyte count returning to
suffering from DF or DHF needs only supportive normal by ninth to tenth day after therapy in most of the
treatment therefore, it is important to have strong clinical cases.24 It indicates that leukocyte count is an important
suspicion before initiating treatment. The below- benchmark for clinical improvement. It is also supported
mentioned signs and symptoms when combined with the by S. B. Halsted study who observed decrease in WBC
triad of raised hematocrit, thrombocytopenia and elevated count from 3rd day and increase in it by 8th and 9th day.2
liver enzymes are the main indicators of DF or DHF. In present study there was no significant differences
Classic DF is usually a self limiting-febrile illness, between HCT of 1st, 3rdand 7th day according to mean and
whereas, DHF can cause a life threatening disease. standard deviation (P >0.05). The reason for this is
Without proper treatment, DHF case fatality rates can because hemoconcentration usually occurs in patients
exceed 20% whereas with supportive therapy; it can be with dengue shock syndrome and was not much altered in
reduced to less than 1%.14 classical dengue fever. Rusmavati et al, study who also
observed similar findings.25
In the present study, there was a male predominance with
about 63.4% of patients being male and 36.6% female. In present study increased AST level was observed in
Sharma S et al, Rashmi et al, Agarwal et al also found the 79.3% patients, Rachel et al study also observed increased
similar findings.15-17 This is due to the Asian culture AST level in 83.9% patients, Nazish Butt et al observed it
whereby males spend more time outside their houses and in 100% patients.20,14 In present study, increased ALT
are more likely to be exposed to mosquitoes compared to level was observed in 42.7% patients. Priyanka et al,
females. In present study, majority of patients were study also observed increased ALT level in 40% patients,
observed in month of September, October and November. whereas Raman et al observed it in 92% patients.19,22 In
Trupti et al, also found the similar findings.18 In present present study, majority patients had classical dengue
study, all patients had fever (100%) and rash was fever 62.20%, followed by DHF I (17 %), DHF II (14.6
observed in 15.6% cases. In present study, 12 (14.6%) %), DHF III (3.6 %). It is supported by study conducted
patient had positive tourniquet test, while in Raman et al, by Raman et al who also observed classical dengue fever
it was 6%, Rachel et al study, it was in 33.6% of 56%, DHF I 13 %, DHF II 14.6 % and DHF III 1.5%.19
patients.19,20 In present study, petechia was observed in 11 In present study, cases of DHF IV is 2.4 %, whereas no
(13.4%) patient, while in Regina et al study it was 13.4% cases were observed in Raman et al study.19
and in Raman et al it was in 43% of patients.19,21
In present study, mortality rate was 2.44%. Jain A et al,
In present study, hepatomegaly was observed in 24 study who also observed mortality rate of 1.7% whereas
(29.3%) patients whereas in Raman et al study and it was higher in Ahmed F et al study that is 6.4 %.26,27
Regina et al study it was 10.5% and 10.4% Mortality in dengue infection is mostly due to
respectively.19,21 In present study, thrombocytopenia was hemorrhagic manifestation, fluid leakage and DSS.

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Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105

Shock, multifocal bleeding and neurological 9. Sumathi K, Manjuladevi A, Lakshmi K, Menezes G.

manifestation are poor prognostic manifestations. Highly Role of serum transaminases in dengue fever. Int J
trained staff and enough resources can reduce the Pharm Bio Sci. 2013;4(1):429-33.
mortality even further.27 10. Souza LJ, Nogueira RM, Soares LC, Soares CE,
Ribas BF, Alves FP, Vieira FR, Pessanha FE. The
CONCLUSION impact of dengue on liver function as evaluated by
aminotransferase levels. Brazilian Journal of
Dengue is a self-limiting disease, so by observing above Infectious Diseases. 2007 Aug;11(4):407-10.
parameters, prognosis of dengue can be known. Peak of 11. World Health Organization. Comprehensive
disease is in late monsoon and post monsoon season. It guideline for prevention and control of dengue and
reflects the seasonal trend of dengue and so it can also dengue haemorrhagic fever. 2011.
help in vector control programs. The results of present 12. Park K. Preventive medicine in obstetrics, pediatrics
study have highlighted the importance of clinical and geriatrics. In, Textbook of preventive and social
examination, haematological and biochemical profile in medicine, Jabalpur. 2015.
dengue patients. Variation in hematocrit, leucopenia, 13. Gupta N, Srivastava S, Jain A, Chaturvedi UC.
thrombocytopenia, raised liver enzymes and presence of Dengue in India. Indian J Med Res. 2012;136:373-
various clinical features like fever, headache, rash, 90.
pleural effusion and other gave enough clues so as to 14. Butt N, Abbassi A, Munir SM, Ahmad SM, Sheikh
diagnose dengue cases in their initial stages and thus QH. Haematological and biochemical indicators for
facilitate early treatment and observation of dengue cases. the early diagnosis of dengue viral infection
This would minimize morbidity and mortality arising out haematological and biochemical indicators for the
of serious complications of DF. early diagnosis of dengue viral infection. Coll Phy
Surg Pak. 2008;18(5):282-5.
Funding: No funding sources 15. Sharma S, Sharma SK, Mohan A, Wadhwa J, Dar L,
Conflict of interest: None declared Thulkar S, Pande JN. Clinical Profile of Dengue
Ethical approval: The study was approved by the Haemorrhagic Fever in Adults during 1996-
Institutional Ethics Committee of Government Medical Outbreak in Delhi, India. 1998;22:20-27.
College Surat, Gujarat, India 16. Rashmi MV. Haematological and biochemical
markers as predictors of dengue infection.
REFERENCES Malaysian J pathology. 2015 Dec 1;37(3):247.
17. Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R,
1. Government of India. Guidelines for clinical Mathur A, Misra AK, Srivastava KL, Chaturvedi
management of dengue fever, dengue haemorrhagic UC. A clinical study of the patients with dengue
fever and dengue shock syndrome, 2008. hemorrhagic fever during the epidemic of 1996 at
2. Guzman MG, Halstead SB, Artsob H, Buchy P, Lucknow, India. 1999:740.
Farrar J, Gubler DJ, et al. Dengue: a continuing 18. Dongre T, Karmarkar P. Hematological Parameters
global threat. Nature Reviews Microbiology. 2010 and its utility in dengue–A prospective study. IOSR
Dec 1;8(12supp):S7. J dental and medical sciences. 2015 Feb;14(2):31-4.
3. Screaton G, Mongkolsapaya J, Yacoub S, Roberts 19. Raman MH, Alam AY, Rahman AM, Khan MS,
C. New insights into the immunopathology and Shapla NR, Aleem MA. Presentation, Management
control of dengue virus infection. Nature Reviews and Outcome of Dengue Fever A Study of 200
Immunology. 2015 Dec;15(12):745. Cases. J Medicine. 2013 Apr 12;14(1):18-22.
4. Government of India. National Guidelines for 20. Daniel R, Philip AZ. A study of Clinical Profile of
Clinical Management of Dengue fever. 2015. Dengue Fever in Kollam, Kerala, India.
5. Cunha RV, Oliveira ÉC. Hematological and 2005;29:197-202.
biochemical findings in patients with dengue fever: 21. Daumas RP, Passos SR, Oliveira RV, Nogueira RM,
a current issue. Revista brasileira de hematologia e Georg I, Marzochi KB, Brasil P. Clinical and
hemoterapia. 2012;34(2):78-9. laboratory features that discriminate dengue from
6. Col MB, Col TC, Col GC, Col VS, Brig VK. other febrile illnesses: a diagnostic accuracy study
Dengue: a clinicohaematological profile. Medical J in Rio de Janeiro, Brazil. BMC infectious diseases.
Armed Forces India. 2008 Oct 1;64(4):333-6. 2013 Dec;13(1):77.
7. Lin SF, Liu HW, Chang CS, Yen JH, Chen TP. 22. Patel P, Patel S, Sabalpara M, Shah C Shah N.
Hematological aspects of dengue fever. Gaoxiong yi Study of hematological and biochemical changes in
xue ke xue za zhi= The Kaohsiung journal of dengue fever at tertiary care hospital at Ahmedabad.
medical sciences. 1989 Jan;5(1):12-6. Int J Med Sci Public Heal. 2016;5(1).
8. Mahmuduzzaman M, Chowdhury AS, Ghosh DK, 23. Avarebeel S, Prahlad KA, L. T. Study of clinical
Kabir IM, Rahman MA, Ali MS. Serum and demographic profile of dengue. 2014;1211-30.
transaminase level changes in dengue fever and its 24. Gajera VV, Sahu S, Dhar R. Study of
correlation with disease severity. Mymensingh haematological profile of dengue fever and its
medical journal: MMJ. 2011 Jul;20(3):349-55.

International Journal of Research in Medical Sciences | June 2018 | Vol 6 | Issue 6 Page 2104
Patel M et al. Int J Res Med Sci. 2018 Jun;6(6):2099-2105

clinical implication. Annals of Applied Bio- Ahmedabad with analysis on economic impact. Nat
Sciences. 2016 Aug 10;3(3):A241-246. J Comm Med. 2013 Apr;4:286-90.
25. Norlelawati AT, Salman MS, Naznin M, Asma 27. Ahmed F, Hussain Z, Ali Z. Clinical and
Hanim H, Rusmawati I. A Descriptive Study of hematological profile of patients with Dengue fever.
Blood Films of Patients Serologically Positive for J Med Sci. 2014;22:17-20.
Dengue in Hospital Tengku Ampuan Afzan,
Kuantan. Inter Med J Malaysia. 2010;9(2):35-8. Cite this article as: Patel M, Patel A, Patel A, Patel
26. Jain A, Shah AN, Patel P, Desai M, Somani S, S, Padsala S. Study of haematological, biochemical
Parikh P, Singhal R, Joshi D. A clinico- profile and clinical presentation in dengue positive
hematological profile of dengue outbreak among patients: 82 cases. Int J Res Med Sci 2018;6:2099-
healthcare Professionals in a tertiary care hospital of 105.

International Journal of Research in Medical Sciences | June 2018 | Vol 6 | Issue 6 Page 2105

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