Clinical and laboratory characteristics of patients with dengue hemorrhagic fever manifestations and their transfusion profile

BACKGROUND: Dengue is an infectious disease with a recurring incidence, especially in developing countries. Despite recent economic growth, success in disease control has not been achieved, and dengue has evolved from cyclic epidemic outbreaks to a lack of seasonality. The lack of scientific basis for the proper management of cases with hemorrhagic manifestations, especially regarding transfusion procedures, might contribute to the high death rate in potentially avoidable cases. OBJECTIVE: The aim of the study was to identify the clinical and laboratory manifestations in hemorrhagic dengue fever treated at the emergency services in Rio Branco, AC, Brazil, as well as to describe transfusion characteristics of patients and identify possible prognostic factors. METHODS: A retrospective descriptive study was performed to analyze the distribution of relative frequencies of clinical and laboratory variables. The study was carried out in Rio Branco with confirmed dengue fever cases. Secondary data were obtained by Acre Epidemiological Surveillance teams of cases with bleeding or platelet counts under 100.0 × 10(9)/L. The patients' clinical, laboratory and transfusion data were obtained from hospital records. RESULTS: A total of 90,553 dengue cases were reported of which 7,447 had serologic confirmation; 267 cases had hemorrhagic manifestations and 193 patients were located. Nearly half of the patients had anemia and the mean of the lowest platelet count of these patients was 26.4 × 10(9)/L. Platelet concentrate was transfused in 22.3% of cases with a mean of 7.5 IU/patient, fresh frozen plasma in 21.2% with a mean of 5.2 IU/patient and just 2.6% of patients received concentrated red blood cells with a mean of 3.2 IU/patient. Bleeding led to transfusions. Signs of plasma leakage and cardiopulmonary dysfunction were correlated to unfavorable outcomes. CONCLUSION: The pattern of clinical and laboratory criteria observed in this investigation does not differ from the literature. Transfusions were used as part of the treatment of dengue hemorrhagic fever manifestations. Some of the clinical manifestations may be related to unfavorable outcomes.