What are the mechanisms leading to thrombocytopenia in Dengue (Dengue Fever)?

From the Guidelines

Thrombocytopenia in dengue fever is primarily caused by a combination of direct viral suppression of bone marrow, immune-mediated platelet destruction, and increased peripheral consumption, as evidenced by the complex interplay of mechanisms described in the context of dengue virus infection 1. The dengue virus directly infects bone marrow progenitor cells, suppressing megakaryocyte development and reducing platelet production.

• Key mechanisms include:
  • Direct viral infection of bone marrow cells
  • Immune-mediated platelet destruction
  • Increased peripheral consumption due to platelet adhesion to damaged vascular endothelium and participation in coagulation processes
  • Direct binding of the virus to platelets, causing activation and aggregation
  • Enhanced apoptosis of platelets during infection
• In severe cases, disseminated intravascular coagulation may develop, rapidly consuming platelets and further decreasing platelet counts. The study of dengue and Zika virus diagnostic testing for patients with a clinically compatible illness and risk for infection with both viruses, although primarily focused on diagnostic approaches, highlights the severity of thrombocytopenia as a clinical manifestation, particularly in the context of severe dengue 1. Given the information available, the exact mechanisms leading to thrombocytopenia in dengue fever involve a multifaceted approach including direct effects on platelet production and survival, as well as indirect effects through immune system activation and coagulation pathway alterations.
• Important considerations include:
  • The role of the immune system in mediating platelet destruction
  • The impact of viral infection on bone marrow function and platelet production
  • The potential for severe thrombocytopenia to contribute to morbidity and mortality in dengue fever Overall, understanding the mechanisms of thrombocytopenia in dengue fever is crucial for developing effective management strategies to reduce the risk of bleeding complications and improve patient outcomes.

From the Research

Mechanisms of Thrombocytopenia in Dengue Fever

The exact mechanisms of thrombocytopenia in dengue fever are complex and involve multiple factors, including:

• Platelet activation 2
• Procoagulant and anticoagulant arms of the coagulation system 2
• Complement 2
• Cytokines 2
• Endothelial cells 2

Pathophysiology of Thrombocytopenia

The pathophysiology of thrombocytopenia in dengue fever is not fully understood, but it is believed to involve a combination of factors, including:

• Direct infection of platelets and megakaryocytes by the dengue virus
• Immune-mediated destruction of platelets
• Bone marrow suppression

Clinical Manifestations

Thrombocytopenia in dengue fever can lead to clinical manifestations such as:

• Bleeding 3, 4, 5
• Petechiae 3, 5
• Gum bleeding 3, 5
• Epistaxis 3, 5

Management of Thrombocytopenia

The management of thrombocytopenia in dengue fever is primarily supportive, and may include:

• Platelet transfusions in severe cases 3, 4, 5, 6
• Close monitoring of platelet count and clinical manifestations 3, 4, 5
• Avoidance of non-steroidal anti-inflammatory drugs (NSAIDs) and other medications that may exacerbate bleeding 6