Fibrinogen Metabolism and Disseminated Intravascular Coagulation in Dengue Hemarrhagic Fever

Abstract

Fibrinogen metabolism was studied using 125I fibrinogen in 29 Dengue Hemorrhagic Fever (DHF) patients (twelve with grade 2 and 17 with grade 3 & 4 DHF), Hemostatic studies were also performed to search for evidence of disseminated intravascular coagulation (DIC). The findings indicated that increased fibrinogen consumption as judged by rapid T1 and increased fractional catabolic rate (FCR) of radioactive fibrinogen occur in 58% of grade 2-DHF patients. Moreover 2 patients in this group had hemostatic changes suggesting DIC. In grade 3 & 4 patients, the majority of whom were studied during shock, increased fibrinogen consumption was observed as well as increased FCR in 89% of cases. Evidence of DTC was observed in 13 of 17 cases with latter group. A correlation between the increased fibrinogen consumption, DIC and clinical severity and shock was demonstrated. The role of DIC on the pathogenesis of shock in DHF was discussed. The use of heparin was suggested for patients with prolonged shock and severe acidosis when DIC becomes clinically apparent.