Hemorrhagic fever-Dengue in preg-How safe she is??

Dengue fever is a painful mosquito-borne disease. It is caused by any one of four types of dengue virus, which is transmitted by the bite of an infected female Aedes aegypti mosquito. Common symptoms of dengue include high fever, runny nose, a mild skin rash, cough, and pain behind the eyes and in the joints. However, some people may develop a red and white patchy skin rash followed by loss of appetite, nausea, vomiting, etc. Patients suffering from dengue should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.

Giving unnecessary platelet transfusion may do more harm !!! Dilemma on platelate transfusion : At what level it will be prudent to transfuse Platelates?? Ans; Platelet deficiency is not the cause of death in people suffering from Dengue

According to International guidelines, unless a patient’s platelet count is below 10,000, and there is spontaneous, active bleeding, no platelet transfusion is required.. It, in fact, does more harm than good if used in a patient whose counts are over 10,000.

The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extra vascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper and lower blood pressure is over 40 mmHg, or the patient passes adequate urine. This is all that is required to treat the patient. an make the patient more unwell. Salient points on DHF(Dengue hemorrhagic Fever)-How ?? The rarity of DHF (Dengue Haemorrhagic Fever)  in pregnancy necessitates a high index of clinical suspicion and I must confess I too have missed some cases with fatal outcome. . All patients presenting with sudden continuous high grade fever, headache, backache along with severe myalgias and hemorrhagic manifestations like petechiae and * ecchymoses  must be seriously considered for Dengue. How to diagnose ? Besides serum tests the outcome of mother & foetus depend mainly on degree of bleeding disorders induced by Dengue virus. So if in suspect the following Investigations may be done every day THIS  should include  Hb-%, (anaemia which may be moderate TO severe) , Peripheral blood smear for MP  to exclude MP. , urine complete examination – which is likely to be normal , TLC, DLC, BT, CT, CRT is likely to be within normal limits but it is the platelets will be somewhere 20 000 to 70 000. Similarly Prothrombin index (PTI) –may be 44%  and partial thromboplastin time with kaolin CT may be slow. Despite the transfusion of blood, fresh frozen plasma, platelet concentrate and round the clock uterotonic severe bout of bleeding may occur (PPH as a cause of thrombocytopenia ,This dengue induced thrombocytopenia may elude the obstetrician for APH/PPH. may ensue in many cases if Platelates The rarity of DHF in pregnancy necessitates a high index of clinical suspicion. Patients present with sudden continuous high grade fever, headache, backache along with severe myalgias and hemorrhagic manifestations like petechiae and * ecchymosed.
Investigations: Despite the transfusion of blood, fresh frozen plasma, platelet concentrate and round the clock uterotonic severe bout of bleeding may occur (PPH as a cause of thrombocytopenia ,This dengue induced thrombocytopenia may elude the obstetrician for APH/PPH. may ensue in many cases if Platelates The rarity of DHF in pregnancy necessitates a high index of clinical suspicion. Patients present with sudden continuous high grade fever, headache, backache along with severe myalgias and hemorrhagic manifestations like petechiae and * ecchymosed.
Investigations: Hb-8 g/dl, PBS for MP, negative, urine complete examination - normal, TLC, DLC, BT, CT, CRT within normal limits but platelets were 40,000/pl, prothrombin index (PTI) - 43% and partial thromboplastin time with kaolin (PTTK) - 85%, blood culture - sterile. Suspecting DHF, detection of IgM antibodies against dengue virus done and was found to be positive.
Despite the transfusion of blood, fresh frozen plasma, platelet concentrate and round the clock and uterotonic  there can be  severe bout of bleeding before or after delivery when the patient may pass into  shock with altered sensorium and may have to be shifted to was shifted to intensive care unit. She may develop  developed ecchymotic patches with further  drop of Hb% .

The  rarity of DHF in pregnancy necessitates a high index of clinical suspicion. Patients presenting with sudden continuous high grade fever, headache, backache along with severe myalgias and hemorrhagic manifestations like petechiae and * ecchymosed.
Investigations: Hb-anaemia moderate , PBS for MP, negative, urine complete examination - normal, TLC, DLC, BT, CT, CRT within normal limits but platelets will be somewhere 20 000 to 70 000 ,, prothrombin index (PTI) - 43% and partial thromboplastin time with kaolin (PTTK) - 85%, blood culture - sterile. Suspecting DHF, detection of IgM antibodies against dengue virus done and was found to be positive.
Hb-8 g/dl, PBS for MP, negative, urine complete examination - normal, TLC, DLC, BT, CT, CRT within normal limits but platelets were 40,000/pl, prothrombin index (PTI) - 43% and partial thromboplastin time with kaolin (PTTK) - 85%, blood culture - sterile. Suspecting DHF, detection of IgM antibodies against dengue virus done and was found to be positive.
Despite the transfusion of blood, fresh frozen plasma, platelet concentrate and round the clock ut(^phonics, a severe bout of bleeding occurred 48 hours after delivery when the patient passed in shock with altered sensorium and was shifted to intensive care unit. She developed ecchymotic patches. Hb dropped to 4 g/dl.
With the supportive treatment she became febrile after 4 days. Hemoglobin increased to 7.8 g/dl, platelets - 2,00,000/pl, PTI/PTTK -
within normal limits.
are below 50,000. occurred 48 hours after delivery when the patient passed in shock with altered sensorium and was shifted to intensive care unit. She developed ecchymotic patches. Hb dropped to 4 g/dl.
With the supportive treatment she became febrile after 4 days. Hemoglobin increased to 7.8 g/dl, platelets - 2,00,000/pl, PTI/PTTK -
within normal limits. line (PTTK) - 80%, blood culture - sterile. Suspecting DHF, detection of IgM antibodies against dengue virus done and was found to be positive.
With the supportive treatment she  may became febrile after few  days. Hemoglobin may increase in few cases but not all, Other bleeding diosrder have to be tetes like , A) PTI/PTTK -
within normal limits are) platelates  below 50,000. occurred 48 hours after delivery when the patient passed in shock with altered sensorium and was shifted to intensive care unit. She developed ecchymotic patches. Hb dropped to 4 g/dl.
With the supportive treatment some cases of dengue  may  became febrile after varying no of days.  

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