From the Guidelines
Dengue causes thrombocytopenia through a complex interplay of mechanisms that affect platelet production, survival, and consumption, ultimately leading to a significant decrease in platelet count. The exact mechanisms by which dengue virus causes thrombocytopenia are not fully elucidated in the provided study 1, but based on general medical knowledge, it is understood that the virus can suppress bone marrow function, trigger an immune response leading to platelet destruction, directly infect and damage platelets and megakaryocytes, increase platelet activation and aggregation, and damage vascular endothelium. Some key points to consider in the pathogenesis of thrombocytopenia in dengue include:
- Suppression of bone marrow function, reducing platelet production
- Immune-mediated destruction of platelets
- Direct infection and damage to platelets and megakaryocytes
- Increased platelet activation, aggregation, and consumption
- Damage to vascular endothelium, leading to platelet adhesion and removal from circulation Given the information available and the need to prioritize morbidity, mortality, and quality of life, it is essential to recognize that thrombocytopenia in dengue patients is a critical factor that contributes to the risk of bleeding and severity of the disease. The study 1 discusses the clinical presentation of dengue, including its spectrum of illness, but does not specifically address the mechanisms of thrombocytopenia. However, understanding the pathogenesis of thrombocytopenia in dengue is crucial for managing patients effectively and reducing the risk of complications. In clinical practice, recognizing the signs of thrombocytopenia and monitoring platelet counts are vital components of caring for patients with dengue, especially given the potential for severe outcomes if not properly managed.
From the Research
Mechanisms of Thrombocytopenia in Dengue
- Thrombocytopenia is a common characteristic of dengue infection, observed in both mild and severe cases 2
- The decrease in platelet counts may be due to bone marrow suppression or consumption of platelets at the periphery 2
- Bone marrow suppression can occur through the infection of hematopoietic progenitors and stromal cells, including megakaryocytes, which compromises megakaryopoiesis 2, 3
- Peripheral consumption of platelets can occur through direct infection of platelets by DENV, adhesion of platelets to leukocytes and vascular endothelium, and platelet clearance mediated by anti-platelet antibodies 2, 3
Clinical Outcomes and Platelet Transfusion
- Platelet transfusion is common in dengue patients with thrombocytopenia, but its effectiveness in improving outcomes is still debated 4, 5
- Studies have shown that platelet transfusion may not improve outcomes and may even increase the risk of bleeding in patients with poor platelet recovery 4
- The decision to transfuse platelets should be based on individual patient needs and clinical judgment, taking into account the risk of bleeding and the potential benefits of transfusion 5, 6
Pathophysiology of Thrombocytopenia in Dengue
- The pathophysiology of thrombocytopenia in dengue is complex and involves multiple mechanisms, including platelet activation, procoagulant and anticoagulant arms of the coagulation system, complement, cytokines, and endothelial cells 3, 6
- Platelets play a role in the inflammatory and immune response, promoting cytokine, chemokine, and inflammatory mediator secretion, and may contribute to the development of thrombocytopenia and clinical bleeding 2, 3