Peripheral blood examination to assess bleeding risk in children with dengue infections

Background Dengue viral infection may cause mild to severe clinical manifestations, with or without bleeding. A number of factors may cause bleeding in patients with dengue. However, health providers may be unable to perform the examinations required to sufficiently predict the risk of bleeding. Objective To find risk factors for bleeding using peripheral blood examinations in children with dengue infection. Methods This crosssectional study was conducted at the Pediatric Ward of the Dr. Saiful Anwar General Hospital, Malang, from January 2010 to December 2011. We included children aged 1 to 18 years with dengue viral infection, as confirmed by the 1997 WHO criteria and serology. Peripheral blood examinations were made daily, depending on the patient's condition. We classified the bleeding status into nonbleeding, petechial bleeding (mild hemorrhage), and mucosal bleeding (severe hemorrhage). We recorded subjects' bleeding status at the time of their highest packed cell volume (PCV), and recorded their leukocyte and platelet counts at that time. We computed the parameters' medians and compared them to bleeding status by Chisquare test. For significant (P<0.05) associations we calculated the OR (odds ratio) \\lith a 95% confidence interval. All patients were treated according to the 1997 WHO dengue guidelines. Results There were all 294 subjects with dengue and 282 subjects had complete data, 202 \\lith bleeding (120 petechial, 82 mucosal bleeding) and 80 without bleeding. The median PCV was 36.8%, while median platelet count was 51,000/,uL and median leukocyte count was 3,400/,uL. The OR of PCV > 36.8% for bleeding was 2.31 (95%CI 1.35 to 3.95). The OR of platelet count <51,000/ ,uL for bleeding was 2.34 (95%CI 1.37 to 3.99) compared to platelet count> 51,000/ ,uL. The OR of platelet count < 51,000/ ,uL for mucosal bleeding was 3.39 (95%CI 1.78 to 6.48). Chisquare analysis for leukocyte count showed it was not associated with bleeding in dengue (P 0.186). Conclusion The PCV level > 36.8% increased the risk for bleeding by 2.31 times, for both petechial and mucosal bleeding. Platelet count < 51,000/ ,uL increased the risk for bleeding 2.34 times and for mucosal bleeding by 3.4 times. Leukocytes count was not associated with bleeding. Basic laboratory examinations of PCV and platelet count may, therefore, be used as a predictor of bleeding in children with dengue infection. [paediatr lndones. 2012;52:175-80]