Peripheral blood examination to assess bleeding risk in children with dengue infections
Abstract
Background Dengue viral infection may cause mild to severe
clinical manifestations, with or without bleeding. A number of
factors may cause bleeding in patients with dengue. However,
health providers may be unable to perform the examinations
required to sufficiently predict the risk of bleeding.
Objective To find risk factors for bleeding using peripheral blood
examinations in children with dengue infection.
Methods This crossô€sectional study was conducted at the
Pediatric Ward of the Dr. Saiful Anwar General Hospital,
Malang, from January 2010 to December 2011. We included
children aged 1 to 18 years with dengue viral infection, as
confirmed by the 1997 WHO criteria and serology. Peripheral
blood examinations were made daily, depending on the patient's
condition. We classified the bleeding status into nonô€bleeding,
petechial bleeding (mild hemorrhage), and mucosal bleeding
(severe hemorrhage). We recorded subjects' bleeding status at
the time of their highest packed cell volume (PCV), and recorded
their leukocyte and platelet counts at that time. We computed
the parameters' medians and compared them to bleeding status
by Chiô€square test. For significant (P<0.05) associations we
calculated the OR (odds ratio) \\lith a 95% confidence interval.
All patients were treated according to the 1997 WHO dengue
guidelines.
Results There were all 294 subjects with dengue and 282
subjects had complete data, 202 \\lith bleeding (120 petechial,
82 mucosal bleeding) and 80 without bleeding. The median
PCV was 36.8%, while median platelet count was 51,000/,uL
and median leukocyte count was 3,400/,uL. The OR of PCV
> 36.8% for bleeding was 2.31 (95%CI 1.35 to 3.95). The OR
of platelet count <51,000/ ,uL for bleeding was 2.34 (95%CI
1.37 to 3.99) compared to platelet count> 51,000/ ,uL. The
OR of platelet count < 51,000/ ,uL for mucosal bleeding was
3.39 (95%CI 1.78 to 6.48). Chiô€square analysis for leukocyte
count showed it was not associated with bleeding in dengue
(Pô€‘ 0.186).
Conclusion The PCV level > 36.8% increased the risk for
bleeding by 2.31 times, for both petechial and mucosal bleeding.
Platelet count < 51,000/ ,uL increased the risk for bleeding 2.34
times and for mucosal bleeding by 3.4 times. Leukocytes count
was not associated with bleeding. Basic laboratory examinations
of PCV and platelet count may, therefore, be used as a predictor
of bleeding in children with dengue infection. [paediatr lndones.
2012;52:175-80].
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Accepted 2016-08-30
Published 2012-06-30
