Complications associated to severe thrombocytopenia in patients with dengue

Background: Thrombocytopenia is a distinctive characteristic of dengue; however, few studies have related thrombocytopenia with its clinical severity. Aim: To identify the complications of dengue, associated to severe thrombocytopenia, defined as a platelets count below 50,000/mm(3)). Patients and Methods: Patients with clinical and serologic (positive IgM) diagnosis of dengue, consulting at hospitals located in Santander, Colombia, during the period 1993-1998, were studied. Clinical findings and laboratory tests (including hematocrit and plalelets counts) were registered. The association between severe thrombocytopenia and the presence of complications, such as hemorrhagic manifestations (positive tournniquet test, petechiae, ecchymoses, bleeding from gums, epistaxis, hematemesis hematuria and metrorrhagia) and signs of plasma leakage (pleural effusions and haemoconcentration), were evaluated using a univariate and multivariate analysis. Results: of the 790 patients enrolled, 502 had a platelet count below 50,000/mm(3). Severe thrombocytopenia was associated with hemorrhagic manifestations (OR= 3.16,- 95% CI: 2.09-4.76; P < 0.0001) and signs of plasma leakage (OR = 2.67; 95% CI: 1.86-3.84; p < 0.0001). The associations between severe thrombocytopenia and the complications of dengue (with exception of bleeding from gums, hematuria and metrorrhagia), were confirmed with the multivariated analysis (P <0.05). Conclusion: There was a strong association between deep thrombocytopenia and the severity of dengue.