A Study on Differential Alteration Trend of Monocyte Count and Other Blood Parameters Among Dengue Patients During Hospitalisation in a Tertiary Care Centre of North India - A Prospective Cohort Study

Introduction: Dengue fever is a viral infection that spreads through mosquito bites. It is a serious public health concern in many tropical and subtropical regions around the world. This study aimed to investigate and analyze differential alteration in various blood parameters specially monocyte count and its trend during the course of hospitalisation among individuals diagnosed with Dengue, providing valuable insights into the hematological alterations associated with the disease. Assessment of Severity of Dengue patients was also done by Dengue scoring. The dengue score is a model for predicting severity of dengue as ascites and / or pleural effusion. This is calculated by using four parameters: Hct > 15.1%, Serum Albumin 2.51. 1 score each is given if present and 0 if absent. The study analyzed several key parameters such as complete blood count (CBC), platelet count, monocyte count, hematocrit levels, and serum biochemical markers. The main objective was to identify patterns and trends in these parameters during various stages of Dengue infection, starting from the early febrile phase to the critical phase, and finally to the recovery phase. The study found that Dengue patients experience significant changes in their blood parameters, indicating that the disease has a dynamic impact on the hematological system. During the febrile phase, patients with Dengue exhibited a noticeable decrease in platelet count and hematocrit levels, which are typical symptoms of Dengue-induced thrombocytopenia and plasma leakage. Additionally, the study revealed variations in CBC parameters, such as monocytosis, leukopenia and changes in differential leukocyte counts, which offer further insights into the immune response against the Dengue virus. Materials and Methods: Study population consisted of 100 adults with Dengue fever and Severe dengue (including those with warning signs and shock). Patients were taken from the wards, and OPD of Dr. Ram Manohar Lohia Institute of Medical sciences, Lucknow, UP. Patients were selected after excluding other causes of acute febrile illness and other causes of severe disease. They were included after ELISA confirmed NS1 and IgM positive cases. Blood sampling was done for other hematological parameters. Clinical and demographic profile were noted after taking proper consent. Results: Analysis of hematological profile of dengue patients showed Lymphocytosis (67%) and Monocytosis (82%) besides thrombocytopenia. 32((96.9%) had monocytosis in severe dengue and 52(77.6%) in dengue fever patients without warning signs. Though results were not statistically significant for the two groups but were important markers for deciding in-patient management SGOT was statistically significant with P-value of 0.008. Bleeding manifestations were significant with P-value <0.00001. Conclusions: Thrombocytopenia is important parameter to diagnose Dengue fever from other febrile illness but monocytosis and its trend over days is an important marker for the prognosis of the severity of dengue patients besides Leucopenia. Key words: Dengue fever, monocytosis, Thrombocytopenia, severe dengue,