Management of Dengue Fever with Severe Thrombocytopenia in a Patient While on Warfarin: A Case Report

                                   https://www.austinpublishinggroup.com/tropical-medicine-care/

Denguefever is a potentially lethal illness that is universally prevalent in the tropics. Dengue hemorrhagic fever is characterized by a ‘leakage phase’ (or critical phase) usually lasting 48 hours following an initial febrile phase. During the leakage phase, an increase in capillary permeability leads to extravasation of fluid and haemoconcentration. During the latter part of febrile phase and early leakage phase (or even later), there is a steady drop in platelet count. Some patients with dengue fever will develop severe thrombocytopenia during the course of the illness even without going into a critical phase and the platelet count does not necessarily indicate the severity of infection.

Atoccasions, it can drop as low as 500/μl in previously healthy individuals (normal platelet count in a healthy adult: 150,000-400,000/μl). The exact mechanism of this drop is unclear but presumed to be immunological. The low platelet count leaves the patient at a significant risk of spontaneous bleeding. The management is further complicated by pre-existing co-morbidities that interfere with the usual therapeutic guidelines. Use of oral anticoagulants is one such situation where management of dengue fever could be challenging. We report a patient with severe dengue infection with very low platelet counts without bleeding manifestations who was on anticoagulation with warfarin for atrial fibrillation with severe mitral regurgitation awaiting prosthetic mitral valve replacement.