Plasma prothrombin time and activated partial thromboplastin time as predictors of bleeding manifestations during dengue hemorrhagic fever
Keywords:
DHF, impaired coagulation, bleeding, APTT
Abstract
Background Massive bleeding and shock are complications ofdengue hemorrhagic fever (DHF) that are associated with
high mortality. Impaired hemostasis, especially coagulopathy,
contributes to bleeding manifestations in DHF. Parameters such
as activated partial thromboplastin time (APTT) and plasma
prothrombin time (PPT) indicate the impact of coagulation
system.
Objective To determine the relationship between APTT and PPT
levels with bleeding manifestations in DHF patients.
Methods A prospective cohort study was applied to subjects
diagnosed with DHF at the Infection and Tropical Diseases
Division, Department of Child Health, Medical School, Udayana
University, Sanglah Hospital, Denpasar, Indonesia. Laboratory
tests to determine APTT and PPT were carried out on the
third, fourth, and fifth day after the onset of fever. Bleeding
manifestations were examined in patients during their hospital
stay. Univariate and Cox regression analyses were performed
to examine relationship between APTT and PPT values with
bleeding manifestations in DHF patients.
Results Forty-three children were enrolled in this study. There
was a significant relationship between increases in APTT value
with bleeding manifestations in DHF patients [RR 2.79 (95%CI
1.68 to 4.69), P <0.01]. Cox regression analysis showed that only
increased APTT values correlated with bleeding manifestations
[RR 2.05 (95%CI 1.92 to 3.90), PÂ =Â 0.02].
Conclusion APTT values may be used as a predictor for bleeding
manifestations in DHF.
References
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diagnosis, treatment, prevention and control. 2nd ed. Geneva:
WHO; 1997.
2. Halstead SB. Dengue fever/dengue hemorrhagic fever. In:
Behrman RE, Kliegman RM, Jenson HB, editors. Nelson
Textbook of Pediatrics. 16'h ed. Philadelphia: WB Saunders,
2000; p. 1005-8.
3. Cherry JD. Dengue and dengue hemorrhagic fever. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious
diseases. Philadelphia: WB Saunders, 1991; p. 1140-8.
4. Djajadiman Gatot. Perubahan hematologi pada infeksi
dengue. Presented at Pelatihan bagi Pelatih Dokter
Spesialis Anak dan Dokter Spesialis Penyakit Dalam dalam
Tatalaksana kasus DBD, Jakarta, November 24-26, 1998.
5. Sutaryo, Pudjo Hagung Wijayanto. Patogenesis koagulopati
pada demam berdarah dengue. In: Sutaryo, Pudjo Hagung
W, Sri Mulatsih, editors. Tatalaksana syok dan perdarahan
pada DBD. Yogyakarta: Medika FK UGM, 2004; p. 30-9.
6. Guzman MG, Kouri G. Dengue: an update. Lancet.
2002;2:33-42.
7. van Gorp ECM, Suharti C, ten Cate H, Dolmans WMV.
Review: Infectious Diseases and Coagulation Disorders. J
Infect Dis. 1999; 180:176-86.
8. Nimmannitya S. Dengue Hemorrhagic Fever: Disorders of
hemostasis. Bangkok] Pediatrics.1999; 24:184-7.
9. McBride W, Ohmann HB. Dengue viral infections:
Pathogenesis and Epidemiology. Microbes and Infection.
2000;2: 1041-50.
10. Guzman MG, Kouri G. Advances in dengue diagnosis.
Journal of Clinical and Diagnostic Laboratory Immunology.
1996;3:621-7.
11. Wills BA, Oragui E E, Stephens A C, Daramola OA, Dung
N M, Loan HT, et al. Coagulation Abnormalities in Dengue
Hemorrhagic Fever: Serial Investigations in 167 Vietnamese
Children with Dengue Shock Syndrome. J Clin Infect Dis.
2002;35:277-85.
12. Phuong CXT, Nhan NT, Thuy PTT, Thien CV, Nga NTT,
Thuy TT et al. Clinical diagnosis and assessment of severity
of confirmed dengue infections in Vietnamese children: is
the World Health Organization classification system helpful?
Am J Trap Med Hyg. 2004;70(2): 172-9.
13. Narayanan M, Aravind MA, Ambikapathy P, Prema
R, Jeyapaul MP. Dengue fever-clinical and laboratory
parameters associated with complications. Dengue Bulletin.
2003;27: 108-15.
14. Setiati TE, Mairuhu ATA, Koraka P, Supriatna M, Gillavry
MRM, Brandjes DPM et al. Dengue disease severity in
Indonesian children: an evaluation of the World Health
Organization classification system. BMC Infectious Diseases.
2007;7(22):1-8.
15. Kalayanarooj S, Chansiriwongs V, Nimmannitya S. Dengue patients at the Children's Hospital, Bangkok: 1995-1999
review. Dengue Bulletin. 2002;26:33-43.
16. Mitrakul C. Bleeding problems in dengue hemorrhagic fever:
platelet and coagulation changes. Southeast Asian J Trop
Med Pub Hlth 1987; 18:407-12.
17. Lei H Y, Yeh T M, Liu H S, Lin Y S. Immunopathogenesis of Dengue Virus Infection. J Biomed Sci. 2001;8:377-88.
18. Chuansumrit A, Tangnararatchakit K. Pathophysiology
and management of dengue hemorrhagic fever. Journal
Compilation Transfusion Alternatives in Transfusion
Medicine. 2006;8:3-11.
19. Krishnamurti C, Kalayanarooj S, Cutting MA, Peat RA,
Rothwell A W, Reid TJ, et al. Mechanisms of hemorrhage in
dengue without circulatory collapse. Am J Trop med Hyg.
2001;65(6):840-7.
20. Liu JW, Khor BS, LeeCH, Lee IK,Chen RF, Yang KD. Dengue hemorrhagic fever in Taiwan. Dengue Bulletin. 2003;27: 19-24.
Published
2009-04-30
How to Cite
1.
Budastra I, Arhana B, Mudita I. Plasma prothrombin time and activated partial thromboplastin time as predictors of bleeding manifestations during dengue hemorrhagic fever. PI [Internet]. 30Apr.2009 [cited 26Nov.2024];49(2):69-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/459
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Received 2016-09-05
Accepted 2016-09-05
Published 2009-04-30
Accepted 2016-09-05
Published 2009-04-30
