From the Guidelines
Dengue fever significantly affects the liver and platelets, leading to liver inflammation, elevated liver enzymes, and thrombocytopenia, which can increase the risk of bleeding and hemorrhage. The virus directly infects liver cells, causing damage that can progress to acute liver failure with jaundice in severe cases 1. Simultaneously, dengue affects platelets through multiple mechanisms, including direct suppression of bone marrow production, immune-mediated destruction, and increased consumption during inflammation, resulting in thrombocytopenia 1.
Key Effects on Liver and Platelets
- Liver inflammation and damage leading to elevated liver enzymes (transaminases) and hepatomegaly (enlarged liver)
- Thrombocytopenia (low platelet count) due to direct suppression of bone marrow production, immune-mediated destruction, and increased consumption during inflammation
- Increased risk of bleeding and hemorrhage due to combination of liver dysfunction and low platelets
Clinical Management
Treatment for dengue fever is primarily supportive, focusing on:
- Maintaining hydration
- Monitoring liver function and platelet counts
- Preventing complications
- Platelet transfusions reserved for patients with active bleeding or extremely low counts (typically below 10,000-20,000/μL) 1. Recovery usually occurs within 1-2 weeks as the immune system clears the virus. It is essential to closely monitor patients with dengue fever to prevent and manage potential complications, particularly those related to liver dysfunction and thrombocytopenia.
From the Research
Liver Complications in Dengue Fever
- Liver dysfunction in dengue varies from mild injury with elevation of transaminases to severe hepatocyte injury 2.
- Elevated serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) levels are common in dengue patients, with 74.2% of patients showing liver involvement in the form of elevated transaminases 2.
- Liver damage is one of the common complications of dengue, and transaminitis, hypoalbuminemia, and reversal of A:G ratio should be used as biochemical markers in dengue patients to detect and monitor hepatic dysfunction 2.
- Adult dengue patients have a lower prevalence of bleeding tendency and greater prevalence of abnormal liver function tests than children with dengue infections, with at least two-thirds of adult dengue patients having abnormal liver function tests 3.
Platelet Complications in Dengue Fever
- Thrombocytopenia is an important characteristic during dengue virus (DENV) infection, being observed both in mild and severe dengue, although the lowest platelet counts are encountered during severe cases 4.
- The decrease in platelet counts may be due to bone marrow suppression or consumption of platelets at the periphery, with mechanisms including infection of hematopoietic progenitors and stromal cells, direct infection of platelets by DENV, adhesion of platelets to leukocytes and vascular endothelium, and platelet clearance mediated by anti-platelet antibodies 4.
- Platelet counts do not correlate well with clinical bleeding, although serious bleeding is rare, and patients should be monitored closely for hemorrhagic manifestations and thrombocytopenia 5.
- Platelet transfusions as a treatment for thrombocytopenia have no clear benefits in reduction of severe bleeding or improvement of the platelet count in the setting of dengue 6.
Relationship between Liver and Platelet Complications
- Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels negatively correlate with platelet count, indicating that liver involvement and thrombocytopenia are related in dengue patients 2.
- Patients with elevated SGOT and SGPT had a higher incidence of bleeding manifestations, suggesting a link between liver dysfunction and platelet complications in dengue fever 2.