Thrombocytopenia in Dengue Hemorrhagic Fever

Dengue hemorrhagic fever is associated with increase in plasma leakage, thrombocytopenia and bleeding tendency.

Few theory has been proposed for the development of thrombocytopenia in dengue hemorrhagic fever. Among the theory are

1) Dengue virus-induced bone marrow suppression resulting in decrease platelet synthesis.

2) Underlying immunological function

a) Immune complex formation (PAIgG formation involving anti-dengue virus IgG)

b) Overproduction of IL-6 enhanced production of anti-platelet agent

c) phagocytosis by THP 1 cell (Human acute monocytic leukemia cell line)

3) Platelet dysfunction due to release of adenosine diphosphate

4) peripheral sequestration and consumption of platelet

Reference:

1) Chulee Mutrakul, Makumkrong Pshyachinda, Prasit Futrakul, et al, “Hemostatic and Platelet Kinetic Studies in Dengue Hemorrhagic Fever", Am. J. Trop. Med. Hyg., 26(5), pp. 975-984, The American Society of Tropical Medicine and Hygiene, 1977

2) Dengue Guidelines for Diagnosis, Treatment, Prevention and Control, World Health Organization, 2009

3) Huan-Yao Lei, Trai-Ming Yeh, Hsiao-Sheng Liu et al, "Immunopathogenesis of dengue virus infection ", Journal of Biomedical Science Volume 8, Number 5,

4) Kazunori Oishi, Shingo Inoue, Maria T.D.D. Cinco et al, "Correlation between increased platelet-associated IgG and thrombocytopenia in secondary dengue virus infections”, J. Med. Virol. 71:259–264, 2003. © 2003 Wiley-Liss, Inc.

5) La Russa VF, Innis BL. “Mechanism of dengue virus-induced bone marrow suppression”, Bailliere’s Clin Hematol 1995;8:249–70.