Haemogram profile of dengue fever in adults during 19 September 12 November 2008: A study of 40 cases from Delhi Sonia Advani, # Shikha Agarwal & Jitender Verma Department of Biotechnology Engineering, College of Engineering and Technology, IILM Academy of Higher Learning, Greater Noida, Uttar Pradesh, India. Abstract Dengue illness appears similar to other febrile illnesses in its early stages, which means its diagnosis is often delayed or confused with other illnesses. To address this issue, we analysed the haemogram profile of 40 patients (>12 years) hospitalized with DHF in Delhi from 19 September to 12 November 2008 to predict outbreaks and severity levels of the disease. Such studies could prove useful in disease management, diagnosing dengue and predicting the likelihood of haemorrhaging. All the patients were diagnosed, managed and monitored according to a standard protocol. Of the 40 patients who fulfilled the World Health Organization (WHO) criteria of DHF, 30 (75%) were male. All patients presented with fever and IgM dengue serology was positive in 100% cases. The haemogram profile shows that the lymphocyte level is a highly deviated parameter whereas the red blood corpuscles (RBC) count and mean corpuscular haemoglobin concentration (MCHC) are the least deviated parameters after performing standard deviation tests. Keywords: Dengue; Haemogram profile; RBC count; WBC count; MCH; MCHC; Lymphocyte; Delhi. Introduction Little is known about the pattern and dynamics of dengue virus in outbreak situations. [1] Dengue fever is a mosquito-borne flaviviral infection endemic in the tropics and subtropics, affecting up to 100 million people. [2] Four distinct dengue viral serotypes (DENV-1 4) are known to cause the illness. [3] The presence of the virus in the blood vessels causes changes to these blood vessels. The vessels swell and leak. The spleen and lymph nodes become enlarged and patches of the liver tissue die. A process called disseminated intravascular coagulation (DIC) can occur. [4] After the virus has been transmitted to the human host, a period of incubation occurs, and many infections may be asymptomatic. During this time, the virus multiplies. When present, symptoms of the disease appear suddenly and include high fever, chills, headache, eye pain, red eyes, enlarged lymph nodes, a red flush to the face, lower back pain, extreme weakness, and severe aches in the legs and joints. This initial # E-mail: sonia.advani@iilm.ac.in Dengue Bulletin Volume 35, 2011 71
period of illness lasts about two or three days. After this time, the fever drops rapidly and the patient sweats heavily. After about a day of feeling relatively well, the patient s temperature may increase again. [5] The laboratory profile provides the preliminary route to investigation and the objective of this work was to predict outbreaks and severity levels of the dengue disease. [6] Materials and methods Patients admitted with fever, headache, myalgia and retro orbital pains were taken up for the study. Haemogram profiles of dengue-positive patients were collected with permission from patients admitted in the Lok Nayak Jai Prakash Narain Hospital, Bhagwati Diagnostic Centre and Mayur Diagnostic Centre, all in Delhi. Other causes of fever like malaria, leptospirosis, enteric fever and respiratory infections were excluded by appropriate tests. Results Forty patients were evaluated, of which 30 (75%) were male. Dengue fever, headache and myalgia were the common clinical features. IgM dengue serology was positive in 100% cases. For all patients, the haemogram profile consisting of various parameters such as mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), lymphocyte count, platelet count, white blood cell (WBC) count, red blood corpuscles (RBC) count, mean corpuscular volume (MCV) and haemoglobin count were tabulated (Table 1). The deviation of the above parameters from the reference values was calculated by the method of standard deviation (Table 2). Most patients had a platelet count of between 25 000/mm3 and 50 000/mm3 (56%). The RBC count and MCHC were observed to be the least deviated parameters in dengue patients whereas lymphocyte count was the highest deviated parameter. From the data (Table 1), it was also inferred that platelet level is a good indicator of dengue infection. Discussion Dengue fever was noted in adults during 19 September 12 November 2008. Standard deviation for each parameters was individually calculated from the normal values, using formula, Standard deviation (s) = ( X 2 /N) 1/2 where X = deviation from normal value and N = number of patients. The most deviated parameter was identified using the above calculation. Difference in normal values for male and female patients required separate graphical representations for each parameter. From Table 2 it was inferred that some parameters are highly deviated and some slightly deviated. MCH is the least deviated parameter in dengue patients whereas neutrophil is a 72 Dengue Bulletin Volume 35, 2011
Table 1: Haemogram profile of 40 dengue patients Patient no. Sex Reference values MCH 26.3 33.8 MCHC 32 36 Platelet Lymphocyte WBC count (x10e3) µl 140 450 20 45 5000 11 000 RBC (x10e6) µl 5.5±1: M 4±1: F MCV fl 80 100 fl HB 15.5±2: M 13.5±2: F 1 F 31.2 35.9 28 22 6.9 5.5 86.9 14.2 2 M 32.5 36.4 66 30 7 4.52 90.7 13 3 M 32.4 36.3 60 30 5.1 5.02 89.3 14 4 M 31.3 35.2 60 37 4.43 4.9 86.9 14.4 5 M 31.3 30.1 53 37 6.29 3.55 103.9 11.1 6 M 32.1 37.7 64 32 6.5 1.443 85.8 12.2 7 M 31.8 35.5 40 57 8.2 3.77 89.7 12 8 F 30.9 36 79 19 9.7 3.49 86.2 10.8 9 M 30.8 35.5 40 58 8.7 3.55 87.2 8.6 10 F 27.1 32.7 55 42 5.25 4.68 82.9 12.7 11 M 34.9 34.26 55 49 7.8 4.44 96.4 15.9 12 M 32.1 33.79 46 50 7.9 3.89 83.5 12.3 13 F 33.1 37.1 43 45 7.8 3.79 86.7 15.4 14 M 32.3 31.6 57 41 7.5 2.26 102.2 12.6 15 M 35.8 34.8 49 67 5.7 4.49 95.5 14.8 16 M 27.2 36.6 48 53 11.9 4.29 74.5 11.7 17 F 33.3 34.5 49 62 5.7 4.49 95.5 14.6 18 M 33.1 37.5 53 54 4.7 3.66 88.8 11.6 19 F 34.1 35.4 50 46 5.8 3.44 88.6 11.6 20 F 33.7 38.6 45 58 4.9 2.17 69.5 9.4 21 M 40.7 38.6 42 46 6.2 2.85 102.0 13.9 Dengue Bulletin Volume 35, 2011 73
Patient no. Sex Reference values MCH 26.3 33.8 MCHC 32 36 Platelet Lymphocyte WBC count (x10e3) µl 140 450 20 45 5000 11 000 RBC (x10e6) µl 5.5±1: M 4±1: F MCV fl 80 100 fl HB 15.5±2: M 13.5±2: F 22 M 28.3 37.6 48 66 7.8 4.22 65.3 13.2 23 M 35.6 35.6 46 44 7.6 3.76 85.3 12.5 24 M 32.7 34.3 50 60 5.5 2.18 70.3 15.6 25 M 26.5 36.8 52 61 6.3 2.88 103.4 14.3 26 M 39.3 37.8 42 43 7.7 4.68 96.7 11.4 27 F 31.4 33.2 41 57 10.2 3.87 68.3 13.7 28 M 28.6 31.7 57 55 10.6 3.80 73.8 15.7 29 M 34.8 38.8 45 42 4.8 2.44 103.8 14.6 30 M 40.6 33.7 59 48 8.9 2.65 97.4 9.7 31 M 33.2 37.8 40 45 5.7 2.79 86.8 12.8 32 M 38.8 35.7 54 62 7.3 3.48 94.8 10.8 33 M 28.7 34.9 49 50 11.6 3.67 101.2 13.5 34 F 29.3 31.5 43 53 6.8 3.13 63.6 11.3 35 M 30.9 32.3 53 59 4.7 3.59 91.5 10.13 36 M 39.1 36.8 47 66 9.8 3.92 102.6 14.7 37 M 34.6 38.5 51 67 5.6 3.28 74.3 10.5 38 M 31.7 36.4 41 49 10.5 3.70 95.7 12.7 39 M 32.6 35.4 46 41 6.7 4.47 86.3 9.3 40 F 27.8 37.6 48 46 5.4 4.58 69.3 10.4 MCH: Mean corpuscular haemoglobin (picograms/cell). MCHC: Mean corpuscular haemoglobin concentration (). WBC: Count: White blood cell count (x10e3) µl. RBC: Red blood corpuscles count (x10e6) µl. M: Male; F: Female. 74 Dengue Bulletin Volume 35, 2011
Table 2: Standard deviation for different parameters [this study] Parameter Standard deviation (s) RBC count 0.89 MCHC 1.71 Haemoglobin 1.91 WBC count 2.02 MCH 3.51 Platelets 8.75 Lymphocyte 11.87 RBC: Red blood corpuscles count. MCHC: Mean corpuscular haemoglobin concentration. WBC count: White blood cell count. MCH: Mean corpuscular haemoglobin. highly deviated parameter. Platelet count is the most effective way of checking the status of the dengue patient. This analysis takes into account only some parameters which give a better insight into the status of the disease. References [1] Vaughn DW, Barrett A, Solomon T. Flaviviruses (Yellow Fever, Dengue, Dengue Hemorrhagic Fever, Japanese Encephalitis, West Nile Encephalitis, St. Louis Encephalitis, Tick-Borne Encephalitis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 7th ed. Philadelphia: Pa: Elsevier Churchill Livingstone, 2009. Chap 153. [2] Gibbons RV, Vaughn DW. Dengue: an escalating problem. BMJ. 2002 29; 324(7353):1 563-6. [3] Birnbaumer DM. Fever in the Returning Traveler. In: Slaven EM, Stone SC, Lopez FA, eds. Infectious Infectious diseases: emergency department diagnosis and management. New York: McGraw Hill, 2007. pp. 418-427. [4] Ward DI. A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg. 2006; 75(1): 182-5. [5] [6] Abrol A, Dewan A, Agarwal N, Galhotra A, Goel NK, Swami HM. A clinico-epidemiological profile of dengue fever cases in a peri-urban area of Chandigarh. The Internet Journal of Epidemiology. 2007; 5(1). Goel NK, Gurpreet, Swami HM. Epidemiological characteristics of dengue fever: its prevention and control. The Internet Journal of Biological Anthropology. 2007; 1(1). Dengue Bulletin Volume 35, 2011 75