Study of Partial Thromboplastin Time And Prothrombin Time As A Predictor Of Bleeding In Dengue Infection “– One Year Cross Sectional Study

Abstract

NTRODUCTION: Dengue is a systemic viral infection which is transmitted by mosquitoes such as Aedes aegypti or Aedes albopictus. Dengue fever is characterized by fever , headache, muscle or joint pain and rash. Dengue virus is of 4 subtypes DNV1,DNV2, DNV3, DNV4.All 4 can cause full spectrum of disease from subclinical cases ,mild self limiting infection ,dengue fever ,fatal cases like dengue hemorrhagic fever(DHF) and dengue shock syndrome(DSS).DHF and DSS are related to multiple factors that include thrombocytopenia, coagulopathy and vasculopathy. Coagulopathy results in derangement of activated partial thromboplastin time which is an indicator of impending bleeding risk. OBJECTIVES: To measure aPTT levels in dengue virus infection and to identify the role of aPTT in comparison with thrombocytopenia as an indicator of bleeding manifestation to assess the real need of platelet transfusion. MATERIALS AND METHODS: A prospective study was conducted from January to august in 2018 in KLE Hospital(JNMC- BELGAVI).Patients with febrile thrombocytopenia who are positive for dengue fever(NS1Ag or IgM) were included in the study. Daily monitoring of platelet count and analysis of aPTT levels were done. aPTT was considered abnormal if it was more than 33 seconds. Patient were followed up for evidence of leaking and bleeding manifestation. RESULTS: Out of 100 patients 88 patients had bleeding manifestation. Bleeding signs were seen on clinical examination in 60 patients. Signs of capillary leak was found in the form of pleural effusion in 11 and ascites in 22 patients. Elevated aPTT levels were seen in 43 patients. Among patient with increased aPTT and thrombocytopenia platelet transfusion were done. CONCLUSION: Our study showed significant correlation between bleeding manifestations and prolonged aPTT levels as well as thrombocytopenia with abnormal aPTT levels. Prolonged aPTT can be used as a predictor of bleeding manifestation especially in DHF and DSS.