Published: 2018-12-26

Significance of APTT as early predictor of bleeding in comparison to thrombocytopenia in dengue virus infection

Hamsa B. T., Srinivasa S. V., Prabhakar K., Raveesha A., Manoj A. G.


Background: Dengue is a systemic viral infection transmitted by mosquitoes such as Aedes aegypti or Aedes albopictus. Dengue Fever (DF) is characterized by fever, headache, muscle or joint pain, and rash. The spectrum of dengue virus infection spreads from an undifferentiated fever and dengue fever (DF) to dengue haemorrhagic fever (DHF) with shock. Factors responsible for bleeding manifestations in dengue are vasculopathy, thrombocytopenia, coagulopathy, and disseminated intravascular coagulation (DIC). Coagulopathy results in derangement of activated partial thromboplastin time (APTT) which is an indicator of impending bleeding risk.

Methods: A prospective study was conducted from June to December in 2017 in R L Jalappa Hospital. Patients aged above 18 years with febrile thrombocytopenia who are positive for dengue virus serology (NS1Ag and/ or IgM) were included in the study. Serial daily monitoring of platelet count and analysis of APTT levels were done. APTT was considered abnormal if it was more than 33.8s. Patients were followed up for evidence of leaking and bleeding manifestations.

Results: Out of 170 patients 28.1% patients had bleeding manifestations. Bleeding signs were seen on clinical examination in 52.37% of patients. capillary leak was found in the form of Pleural effusion in 35.3%, Ascites in 41.2% and Periorbital edema in 31.2% of patients. Elevated APTT levels were seen in 110(64.7%) patients. Among patients with abnormal APTT platelet transfusion was done in 78.9% of patients, and among those with normal APTT levels platelet transfusion was done in 21.1% of patients.

Conclusions: Our study showed significant correlation between bleeding manifestations and prolonged APTT levels as well as thrombocytopenia with abnormal APTT levels. Study concluded that 21.1% of platelet transfusions could have been prevented considering prolonged APTT as a predictor of bleeding manifestation, thus saving the resources and reactions due to platelet concentrate transfusion.


APTT in dengue, APTT vs Dengue, Early prediction of bleeding, Platelet transfusion in Dengue, Severity in Dengue, Thrombocytopenia

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Abhilash K, Kala SN, Sheetal S, Jobin P, Sreerag A S. Coagulopathy in dengue fever patients. Int J Res Med Sci. 2014;2(3):1070-2.

Bashir BA, Saeed OK, Mohammed BA, Ageep AK. Partial thromboplastin time and prothrombin time as predictors for impaired coagulation among patients with dengue virus infection in red sea State of Sudan. Inter J. 2015;2(1):24-8.

Sanjaya K, Ramya E, Pradeep K. Association of abnormal coagulation tests with dengue virus infection and their significance as early predictors of fluid leakage and bleeding. Sri Lanka J Child Health. 2016;45(3):184-8.

Vibha V, Gajera, Shilpi S, Reeta D. Study of Haematological Profile of Dengue Fever and its Clinical Implication. Annals Applied Bio-Sciences. 2016;3:242-6.

Sellahewa KH. Pathogenesis of dengue haemorrhagic fever and its impact on case management. ISRN Infectious Diseases. 2012 Oct 21;2013.

Wills B, Tran VN, Van NTH. Hemostatic changes in Vietnamese children with mild dengue correlate with the severity of vascular leakage rather than bleeding. Am J Trop Med Hyg. 2009;81:638-44.

Srikiatkhachorn A. Plasma leakage in dengue haemorrhagic fever. Thrombosis Haemostasis. 2009;102:1042-9.

Bridget A, Wills EE, Oragui AC, Stephens OA, Daramola, Nguyen MD, et al. Coagulation abnormalities in dengue hemorrhagic fever: serial investigations in 167 Vietnamese children with dengue shock syndrome. Clin Infectious Dis. 2002;35(3):277-85.

Mairuhu ATA, Mac MRG, Setaiti TE, Soamantri A, Ten HC, Brandjes DPM. Is clinical outcome of dengue-virus infections influenced by coagulation and fibrinolysis? A critical review of the evidence. The Lancet Infectious Dis. 2013;3:33-41.

Krishnamurthi CH, Kalyanarooj SI, Cutting MA, Peat RA, Rothwell SW, Reid TJ et al. Mechanisms of hemorrhage in dengue without circulatory collapse. The Am J Trop Med Hyg. 2001;65(6):840-7.