Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue


  • Anagha A. Joshi Department of Pathology, Kempegowda Institute of Medical Sciences, Research Centre, Bengaluru, Karnataka, India
  • Gayathri B. R. Department of Pathology, Kempegowda Institute of Medical Sciences, Research Centre, Bengaluru, Karnataka, India
  • Swathi Kulkarni Department of Pathology, Kempegowda Institute of Medical Sciences, Research Centre, Bengaluru, Karnataka, India



Atypical lymphocytes, Dengue fever, Lymphocytosis, Thrombocytopenia


Background: Dengue viral infections may occur as epidemics and are of public health concern in India especially due to high mortality in advanced stages. Early diagnosis and treatment reduces the mortality significantly. To assess the utility of atypical lymphocyte counts with relation to platelet counts as a marker for severe dengue.

Methods: A total of 132 serologically proven (by rapid card method) cases of dengue with atypical lymphocytosis (≥10%) and thrombocytopenia (<150×109/l) were analyzed during November 2016. The complete blood counts (obtained from automated hematology analyzer and Leishman stained peripheral smears) were analyzed.

Results: Dengue infections were mostly seen in younger age (12-25 years) with slight male predominance. The relevant haematology findings noted were leukopenia in 36% and severe thrombocytopenia (<50×109/l) in 57% of cases. The differential count showed lymphocytosis in 64% with significant (≥20%) atypical lymphocytes in 52% which inversely correlated with platelet counts. Atypical lymphocytosis (≥20%) was noted in 9% of cases with mild as against 32% of severe thrombocytopenia.

Conclusions: Atypical lymphocyte count can be used as predictor of severe thrombocytopenia and severe dengue. This helps in early diagnosis and proper management and drastic reduction in mortality.


Patel PM, Patel SK, Sabalpara MA, Shah CK, Shah NR. Study of hematological changes in Dengue fever at tertiary care hospital in Ahmedabad. Int J Med Sci Public Health. 2016;5(9):1934-6.

Giri R, Agarwal K, Verma S, Verma R, Lipok. A study to correlate level of thrombocytopenia with dengue seropositive patients and frequency of bleeding pattern. Sch. J App Med Sci. 2016;4(1C):214-8.

Meena KC, Jelia S, Meena S, Arif M, Ajmera D, Jatar VS. A study of hematological profile in dengue fever at tertiary care centre, Kota, Rajasthan, India. Int J Advances Med. 2016;3(3):621-4.

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.

Khatri K, Rajani A, Khalla AR. Plasmacytoid lymphocytes: a diagnostic clue to dengue infection. Int J Sci Res. 2016;5(3):1002-05.

Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S, Sahassananda D, Jittmittraphap A, Suwannakudt P, et al. Identification of clinical factors associated with severe dengue among Thai adults: a prospective study. BMC Infect Dis. 2015;420-31.

Kale AV, Haseeb M, Reddy S, Khan S, Golwalkar A, Badaam KM. Clinical profile and outcome of dengue fever from a tertiary care centre at Aurangabad, Maharashtra, India. J Dental Med Sci. 2014;13(9):14-9.

Srikiatkhachorn A, Rothman AL, Gibbons RV, Sittisombut N, Malasit P, Ennis FA et al. Dengue: how best to classify it. Clin Infect Dis. 2011;53(6):563-7.

Pongpan S, Wisitwong A, Tawichasri C, Patumanond J. Prognostic indicators for dengue infection severity. Int J Clin Pediatr. 2013;2(1):12-8.

Shetty A, Kasukurti P, Vijaya C, Jyalakshmi VJ. The reactive lymphocyte: a morphological indicator of platelet counts in dengue seropositive patients. Ann Pathol Laboratory Med. 2016;3(3):217-21.

Patel K, Patel D, Das VK. Hematological parameters and its utility in dengue fever: a prospective study. Int Journal of Science and Research. 2016;5(4):1077-9.

Jayashree K, Manasa GC, Pallavi P, Manjunath GV. Evaluation of platelets as predictive parameters in dengue fever. Ind J Hematol Blood Transfusion. 2011;27(3):127-30.

Badave GK, Swaroop PS, Rao PN. Importance of NS1 antigen detection and its association with platelet count for early diagnosis of dengue virus infection. Int J Current Microbiol Applied Sci. 2016;4(3):779-84.

Agrawal A, Pansuriya H, Dhruva G. Platelet count and hematocrit as early indicators in acute dengue illness. Int J Res Med. 2013;2(2):63-6.

Azin FRFG, Goncalves RP, Pitombeira MHS, Lima DM, Branco IC. Dengue: profile of hematological and biochemical dynamics. Rev Bras Hematol Hemoter. 2012;34(1):36-41.

Jampangern W, Vongthoung K, Jittmittraphap A, Chongsanguan M. Characteristics of atypical lymphocytes and immunophenotypes of lymphocytes in patients with dengue virus infection. Asian Pacific J Allergy Immunol. 2007;25(1):27-36.

Mehta RC, Goswami HM, Katara RK, Patel PS, Parikh UV, Vegad MM, et al. Importance of complete blood count and peripheral smear in early diagnosis of dengue patients. J Infectious Dis Letters. 2013;2(1):22-4.

Rey-Caro LA, Bac, Villar-Centeno LA. Atypical lymphocytes in dengue: role in diagnosis and prognosis of disease. A systematic review of literature. Health Sci J. 2012;10(3):323-35.

Gajera VV, Sahu S, Dhar R. Study of hematological profile of dengue fever and its clinical implications. Ann Applied Bio Sci. 2016;3(3):241-6.

Yacoub S, Willis B. Predicting outcome from dengue. BMC Med. 2014;12:147.

Ali N, Usman M, Syed N. Hemorrhagic manifestations and utility of hematological parameters in dengue fever: a tertiary care centre experience in Karachi. Scandinavian J Infect Dis. 2007;39(11):12.

Vulavala S, Reddy Y, Kamarthy P. Study of clinical and lab profile of dengue fever patients. Eu J Pharm Med Res. 2016;3(11):613-6.

Malathesha MK, Ashwini HN. Hematological manifestations in dengue fever: an observational study. J Evolution Med Dental Sci. 2014;3(9):2245-50.

Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infections. Postgraduate Med J. 2004;80(948):588-601.

Dhir G, Dhir T, Suri V, Dhir D, Khatri K. Hematological and serological test profile in dengue, dengue hemorrhagic fever and dengue shock syndrome in Bathinda region of Punjab. Sch J App Med Sci. 2015;3(8C):2926-30.




How to Cite

Joshi, A. A., B. R., G., & Kulkarni, S. (2017). Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue. International Journal of Research in Medical Sciences, 5(9), 4041–4046.



Original Research Articles