Thromboelastographic Analysis of Hemostatic Abnormalities in Dengue Patients Admitted in a Multidisciplinary Intensive Care Unit: A Cross-sectional Study

BACKGROUND: Dengue fever is an important tropical infection causing significant mortality. The pathophysiology of hematological abnormalities in dengue remains poorly studied. In this study, we analyzed the hematological abnormalities by thromboelastography (TEG). METHODS: This cross-sectional study evaluated complicated dengue patients with TEG. Thromboelastographic variables were categorized into six patterns: factor deficiency, platelet dysfunction, enzymatic hypercoagulability, combined enzymatic and platelet hypercoagulability, primary fibrinolysis, and secondary hyperfibrinolysis. RESULTS: Twenty-five patients were analyzed for coagulation abnormalities by TEG. Coagulation factor deficiency pattern was noted in 11 patients (44%) whereas 3 patients (12%) were found to have low fibrinogen level pattern. Low platelet function was noted in 4 (16%) patients. Enzymatic hypercoagulability and combined enzymatic and platelet hypercoagulability were noted in one patient each (4.5%). Secondary fibrinolysis was noted in 1 patient (5%) and primary fibrinolysis in 3 (15.8%) patients. Factor deficiency pattern and low fibrinogen pattern were not significantly associated with hepatitis (P > 0.05). Activated partial thromboplastin time (aPTT) was not found to be significantly associated with factor deficiency pattern (P = 0.10) and low fibrinogen pattern (P = 0.20). Platelet count was not found to be significantly associated with platelet function (P = 0.54). CONCLUSION: Factor deficiency pattern was the major abnormality noted in dengue patients followed by platelet dysfunction and primary fibrinolysis. Platelet count did not show significant association with platelet function. aPTT did not show significant association with factor deficiency and low fibrinogen patterns. Factor deficiency pattern and low fibrinogen pattern did not show significant association with hepatitis.