Bleeding Manifestations Research Articles

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective: To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue. Methods: This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022. Coagulation tests including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer were performed. Patients were monitored for bleeding manifestations. Results: Coagulation abnormalities were reported in 42.8% of the patients. Overall, prolonged aPTT was the most common coagulation abnormality (40.8%), followed by low fibrinogen (38.7%), raised D-dimer (31.2%), raised INR (26.0%) and prolonged PT (19.2%). Bleeding manifestations were present in 19.9% patients. PT, INR, aPTT and D-dimer levels were significantly higher (P<0.01) and fibrinogen level was significantly lower (P<0.001) in patients with bleeding compared to patients without bleeding. Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding (P<0.01). Conclusions: Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding. Patients with dengue should be assessed for coagulation abnormalities.

Characterization of Novel <i>F5</i> Intronic Variant Associated with Aberrant Splicing and Severe Factor V Deficiency

Congenital factor V deficiency is a rare autosomal recessive bleeding disorder, caused by defects in F5 gene and associated with bleeding manifestations of variable severity. In this study we report molecular and functional characterization of a novel F5 variant which causes aberrant splicing and significantly reduces protein expression in a patient with severe FV deficiency. We performed F5 mutation screening and functional study in a proband (FV:C 0.4%) with a history of gastrointestinal bleeding, post-traumatic bleeding, hematomas, ecchymoses, and discomfort in ankle joints since infancy. Sequencing revealed a novel homozygous F5 gene variant NC_000001.10:169519985GC (or NM_000130.5:c.1297 –8CG). Bioinformatics sequence analysis predicted that this variant would lead to the acceptor site loss of the intron 8/exon 9 junction. However mRN-A analysis identified, that it also activated the aberrant splice site located 7 nucleotides upstream of the normal one and was associated with the production of an anomalous F5 transcript with retention of seven nucleotides of intron 8 resulting in a premature stop codon. We revealed no traces of normal transcript in the patient. Our findings confirm that not only changes in canonical splicing dinucleotides could significantly disrupt the splicing sites and impair pre-mRNA processing.

The Effect of Sickle Cell Hemoglobinopathy on Pregnancy, Labor, Puerperium, and Fetal Outcome: A Retrospective Cohort Study From a Single Centre.

Sickle cell disease (SCD) is a major risk factor as far as pregnancy and obstetric complications are concerned. It possesses major perinatal and postnatal mortality. The management of pregnancy along with SCD requires a multispecialty team consisting of hematologists, obstetricians, anesthesiologists, neonatologists and intensivists. The objective of this study was to investigate the effect of sickle cell hemoglobinopathy on pregnancy, labor, puerperium, and fetal outcome in the rural and urban localities of Maharashtra, India. The present study is a comparative retrospective analysis of 225 pregnant women with SCD (genotype AS and SS) and 100 age- and gravida-matched pregnant women with normal hemoglobin (genotype AA) as a control who were treated between June 2013 to June 2015, in Indira Gandhi Government Medical College (IGGMC), Nagpur, India. We analyzed various data regarding obstetrical outcomes and complications in sickle cell disease mothers. Out of 225 pregnant women, 38 (16.89%) were diagnosed with homozygous sickle cell disease (SS group) while 187 (83.11%) were diagnosed with sickle cell trait (AS group). The most common antenatal complications weresickle cell crisis (17; 44.74%) and jaundice (15; 39.47%) in the SS group whereas pregnancy-induced hypertension (PIH) was noted in 33 (17.65%) in the AS group. Intrauterine growth restriction (IUGR) was recorded in 57.89% of the SS group and 21.39% of the AS group. A higher chance of emergency lower segment cesarean section (LSCS; 66.67% in the SS group and 79.09% in the AS group) was recorded as compared with the control group at 32%. In order to minimize risks to the mother and fetus and for better outcomes it is prudent to manage pregnancy with SCDvigilantly in the antenatal period. In the antenatal period mothers with this disease should be screened for hydrops or bleeding manifestations such as intracerebral hemorrhage in the fetus. Better feto-maternal outcomes can be achieved by effective multispecialty intervention.

Platelet function and soluble P-selectin in patients with primary immune thrombocytopenia

BackgroundThe bleeding phenotype in immune thrombocytopenia (ITP) is heterogeneous, but usually mild and only partly dependent on the severity of thrombocytopenia. Platelet reactivity has previously been suggested to underly the mild phenotype. MethodsPlatelet function was assessed as basal and agonist-induced surface expression of P-selectin and activation of GPIIb/IIIa via flow cytometry, and soluble (s)P-selectin levels were assessed in plasma of 77 patients with primary ITP, 19 hemato-oncologic thrombocytopenic controls (TC) and 20 healthy controls (HC). The association of platelet function with laboratory and clinical parameters such as bleeding manifestations at inclusion and previous thrombosis was analyzed. ResultsITP patients showed tendency towards increased surface P-selectin and elevated levels of activated GPIIb/IIIa. Platelet activation after stimulation with all agonists including TRAP-6, ADP, arachidonic acid and CRP was decreased compared to HC. Compared to TC, only GPIIb/IIIa activation but not surface P-selectin was higher in ITP. Levels of soluble (s)P-selectin were significantly higher in ITP patients compared to TC, but similar to HC. Higher sP-selectin levels were associated with blood group O and current therapy, with highest levels in TPO-RA treated patients. Platelet reactivity was not associated with platelet count or size, platelet antibodies, treatment regime, or blood group. No correlation between platelet activation with the bleeding phenotype or previous thrombotic events could be observed. ConclusionITP patients did not have hyper-reactive platelets compared to HC, but partly higher reactivity compared to TC. Further studies are needed to understand the underlying mechanism behind the bleeding and pro-thrombotic phenotype in ITP.250/250.

Factor XII deficiency: a clinical and molecular genetic study.

Factor XII deficiency is a rare inherited disorder caused by clotting factor XII (FXII, F12) deficiency. It is often asymptomatic but can have both thrombotic and haemorrhagic symptoms. The aim of this study was to describe the spectrum of F12 gene mutations in a Russian population and learn more about the relationship between F12 variants and clinical phenotypes. We obtained and analysed genetic and clinical data from 33 apparently unrelated patients with FXII plasma levels below 60% and genetic data from 26 healthy controls with no history of FXII deficiency. Forty mutant alleles and six different deleterious substitutions were identified. Of these substitutions, three were major in the Russian population (c.-62C > T, c.-57G > C and c.1532-1G > A, total frequency 92.5%) and the three others (p.615 del C, c.1180_1181delCA, and CD218 TAT- > CAT p.Tyr218His) were rare and novel in the world population. Eight patients with mild FXII deficiency were found to be homozygous for a hypomorphic variant of functional polymorphism C46T and have no other deleterious substitutions in the F12 gene. Contrary to data in the literature, our study showed that mild haemorrhagic manifestations are common among patients with FXII deficiency.

Acute Promyelocytic Leukaemia in Adults at Chris Hani Baragwanath Academic Hospital

Background: Acute Promyelocytic Leukaemia (APL) is a subtype of Acute Myeloid Leukaemia (AML). APL is a medical emergency due to its high early mortality rate, most commonly due to bleeding complications resulting from an associated coagulopathy. However, APL is eminently treatable. Aim: The aim of the study was to review the clinical profile as well as the outcome of adult patients presenting with APL, to a tertiary, public sector hospital (Chris Hani Baragwanath Academic Hospital -CHBAH) in Soweto, Johannesburg, South Africa. Patients and Methods: This study entailed a retrospective review of 79 evaluable patients with APL, seen over a 25 year period. Results: Of the 79 evaluable patients, there were 39 males (49.37%) and 40 females (50.63%), with a female to male ratio of 1.03:1. The median age at presentation was 32 years. APL coagulopathy was evident at presentation, with 82.05% of the patients presenting with bleeding and 4.29% presenting with thrombosis. Laboratory evaluation revealed that 93.42% of the patients had anaemia and 97.37% of the patients had thrombocytopenia, while 63.93% of the patients had evidence of a DIC (disseminated intravascular coagulopathy). The Sanz risk score indicated high-risk APL in 26.32% of the patients. HIV seropositivity was present in 17.72% of the patients. After excluding patients with “early mortality’, the median survival was 43.7 months. Conclusion: APL most commonly presents with bleeding manifestations, anaemia, thrombocytopenia and DIC, which contribute to a high “early mortality’ rate. APL is eminently treatable with appropriate supportive care and specific therapy (including ATRA – all trans retinoic acid, arsenic trioxide and chemotherapy). Therefore, early diagnosis and timeous referral of APL patients is of paramount importance in order to decrease the high early mortality and improve the overall outcome of patients harbouring the disease.

Phytochemicals and Regulation of NF-kB in Inflammatory Bowel Diseases: An Overview of In Vitro and In Vivo Effects.

Inflammatory bowel diseases (IBD) are chronic relapsing idiopathic inflammatory conditions affecting the gastrointestinal tract. They are mainly represented by two forms, ulcerative colitis (UC) and Crohn's disease (CD). IBD can be associated with the activation of nuclear factors, such as nuclear factor-kB (NF-kB), leading to increased transcription of pro-inflammatory mediators that result in diarrhea, abdominal pain, bleeding, and many extra-intestinal manifestations. Phytochemicals can interfere with many inflammation targets, including NF-kB pathways. Thus, this review aimed to investigate the effects of different phytochemicals in the NF-kB pathways in vitro and in vivo models of IBD. Fifty-six phytochemicals were included in this study, such as curcumin, resveratrol, kaempferol, sesamol, pinocembrin, astragalin, oxyberberine, berberine hydrochloride, botulin, taxifolin, naringin, thymol, isobavachalcone, lancemaside A, aesculin, tetrandrine, Ginsenoside Rk3, mangiferin, diosgenin, theanine, tryptanthrin, lycopene, gyngerol, alantolactone, mangostin, ophiopogonin D, fisetin, sinomenine, piperine, oxymatrine, euphol, artesunate, galangin, and nobiletin. The main observed effects related to NF-kB pathways were reductions in tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, interferon-gamma (IFN-γ), and cyclooxygenase-2 (COX-2), and augmented occludin, claudin-1, zonula occludens-1, and IL-10 expression levels. Moreover, phytochemicals can improve weight loss, stool consistency, and rectal bleeding in IBD. Therefore, phytochemicals can constitute a powerful treatment option for IBD in humans.

Hirudotherapy for limb ischemia in the pediatric intensive care unit: A retrospective observational cohort.

Acute limb ischemia due to microvascular malperfusion may be refractory to initial therapies. Medicinal leech therapy (hirudotherapy) has been attempted in plastic and reconstructive surgery to improve venous congestion in ischemic flaps; however, there are minimal reports related to ischemia secondary to arterial malperfusion. We evaluated a pediatric cohort from an academic intensive care unit with refractory limb ischemia in whom hirudotherapy was attempted to elucidate its use and outcomes. Institutional patient database was queried to identify pediatric patients (<18 years) who received hirudotherapy in the pediatric critical care unit and met inclusion/exclusion criteria. Patient charts were evaluated for indices including demographics, primary disease, coagulative status, vascular access, vasoactive medication dosing, bleeding, leech use, limb and mortality outcomes. Data was evaluated to identify trends or suspected impact on outcomes. Hirudotherapy was used in 7 patients for limb ischemia, 5 with congenital heart disease, and 2 others with viremic shock. Time to leech application following recognition of ischemia averaged 3 days, with duration of use averaging 3.9 days. Five patients discontinued therapy due to bleeding. Mortality rate was 57%, all secondary to multiorgan failure. In 3 surviving patients, 4 of 5 treated limbs resulted in at minimum partial amputation. Vasoactive-inotropic score tended higher prior to leech application, suggesting a vasoconstrictive pathway for arterial malperfusion. No identifiable trends appeared associated with salvaged limb or adverse effects. Blood loss predictably increased with leech application, as did total transfusion requirement. This case series establishes baseline data for use of hirudotherapy in critically ill children with acute limb ischemia caused by arterial malperfusion. Based on this retrospective cohort, we cannot recommend routine use of hirudotherapy for acute limb ischemia from arterial malperfusion in the pediatric intensive care unit. Application of leeches should be aligned with a protocol defining start and stop parameters, standardized leech utilization, and monitoring for adverse outcomes. Future study would benefit from consensus definitions of study outcomes, including perfusion recovery, tissue/limb salvage and bleeding manifestations. Additional prospective studies are needed prior to any standard or systematic recommendations for use.

Women and girls with haemophilia: A retrospective cohort study in China.

Women and girls with haemophilia (WGH) may have spontaneous/traumatic bleeding similar to that in males with haemophilia, and in addition excessive bleeding during menstruation and delivery. To characterize WGH in China and provide guidance for better management. We retrospectively analysed the characteristics of WGH registered in the Haemophilia Treatment Center Collaborative Network of China(HTCCNC) Registry, including demographics, diagnosis and treatment, bleeding characteristics, obstetrical and gynaecological experiences, and surgical history. A total of 61 females had confirmed haemophilia. Diagnosis and treatment were typically delayed, longer in mild haemophilia than in severe and moderate. The most frequently reported bleeding manifestations were haemarthrosis in severe and moderate patients, and cutaneous bleeding in mild patients. Among 45 postmenarcheal WGH, 21 (46.7%) had history of heavy menstrual bleeding, but only three received treatments. Prenatal diagnosis and management of perinatal haemorrhage were inadequate. Of 34 deliveries in 30 women, nine deliveries were complicated by postpartum haemorrhage, and 22 offspring carried mutations causing haemophilia. Forty-four surgical procedures were performed in 29 patients. Those procedures receiving preoperative coagulation factors coverage were significantly less likely to have excessive bleeding than those who did not (P=.003). This is the first and largest study describing WGH in China. There are currently deficiencies in the identification, diagnosis, and management of these patients. Improving health insurance policies, establishing haemophilia centres, and multidisciplinary teams for bleeding and perinatal or perioperative management will help reduce morbidity and mortality.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Concurrent Occurrence of Nasopharyngeal and Disseminated Cutaneous Rhinosporidiosis: A Rare Presentation.

Clinical profile of hemophilia patients in a tertiary care hospital in Kerala, India: A cross-sectional study

Background: Deficiency of factor VIII (FVIII) (Hemophilia A) and factor IX (Hemophilia B) are the most frequent coagulation defects. The incidence of hemophilia A varies in different regions of India. Aims and Objectives: The present study was done to classify hemophilia A patients by estimating FVIII levels in them and to describe the clinical profile of the patients attending a tertiary care hospital in southern part of India, Kerala. Materials and Methods: A hospital-based cross-sectional study was done on patients with hemophilia A, attending Department of Medicine and Department of Pediatrics from March 2012 to September 2013. Demographic and clinical details were collected using per forma and quantitative assessment of FVIII levels were done using semi-automated blood coagulation analyzer. Results: Out of 90 cases studied, majority of the patients had severe hemophilia (85.6%), followed by mild (10%) and moderate hemophilia (4.4%). Positive family history was seen in 67.8% patients. Median age of the patients at diagnosis was 1 years of age. Most common clinical presentation was found to be hemarthrosis (84.4%) followed by bleeding into muscle (56.7%). Knee joint (75.6%) was the predominantly affected joint. Bony ankylosis (30%), intracranial bleed (14.4%), and retroperitoneal bleed (24.4%) were the most common complications noted. Bleeding manifestations such as gum bleed (24.4%), epistaxis (12.2%), hematuria (37.8%), and ecchymosis (15.6%) were also reported among them. Conclusion: Proportion of severe hemophilia among hemophilia A patients was found to be higher in number than in other parts of the country. Serious complications can result from bleeding into the joints, muscles, brain, or other internal organs. Therefore, promotion of low cost, regular availability of factor concentrates, prophylactic factor replacement, establishing comprehensive care center, and regular training of medical and paramedical staff will help in reducing the complications due to this disease.

BRADYCARDIA-AN ALARMING SIGN IN DENGUE FEVER

Dengue Fever is one of the most common vector borne disease which is caused by bite of Aedes aegypti in Tropical parts of world. Bleeding manifestations are most common signs due to Thrombocytopenia. Relative Bradycardia which is becoming one of the cause of mortality in Dengue Fever. This study aims to observe, changes in Heart rate in Dengue Fever. Materials and methods: This was an observational study done at Narayana medical college and hospital, Nellore, from June 2021 to October 2022 on 150 patients satisfying inclusion and exclusion criteria, demographic data and clinical features and laboratory evaluation was done for patients in the study vitals signs (pulse/heart rate, Blood pressure, respiratory rate, temperature) was noted for all patients. Results: Out of 150 patients, 43.3% have relative bradycardia and 30% patients have absolute bradycardia with ECG showing sinus bradycardia in 28% of patients. Conclusion: Relative bradycardia in dengue fever patients is present in association with thrombocytopenia and is important contributing factor to mortality in patients with dengue fever.

Assessment of soluble syndecan-1 level in adult patients with de novo acute myeloid leukemia and its correlation with hematological parameters and treatment response

BACKGROUND: Syndecan-1 (CD138) is a member of the transmembrane proteoglycans family that is expressed in various normal and malignant tissues. It attracted the attention because of its possible prognostic role when expressed in different tumors as well as its role as a target for therapy by the monoclonal antibody indatuximab coupled with other cytotoxic agents. In acute myeloid leukemia (AML), syndecan-1 was found to be significantly increased either inside leukocytes or as a soluble form in the plasma and it was correlated with overall survival of AML patients and with more bleeding manifestations and impaired platelet function. AIMS: The aims of this study were to assess the level of soluble syndecan-1 (or CD 138) in adult patients with de novo AML compared to the control group and to explore any possible correlation between the level of syndecan-1 with hematological parameters and response to remission induction therapy. PATIENTS AND METHODS: Cross-sectional study recruited 60 newly diagnosed adult AML patients. Moreover, 25 healthy individuals were included as the control group. The peripheral blood and bone marrow smears were examined at presentation for establishing the diagnosis and after remission induction for assessing the treatment response. Plasma syndecan-1 assay was done by sandwich enzyme-linked immunosorbent assay, which was done to patients at time of diagnosis. RESULTS: Plasma syndecan-1 (SDC-1) level of AML patients at presentation was much higher than that in the control group (P &lt; 0.001); there was also a statistically significant difference in plasma level of syndecan-1 between male and female patients (P = 0.002). There was no significant difference for plasma (SDC-1) level between different AML French American British (FAB) subtypes; however, the highest level was seen among patients with the M3 subtype. No significant difference for plasma (SDC-1) level was seen between the patients who achieved remission status and patients who failed to achieve remission after chemotherapy and also between patients alive and deceased after 6 months of follow-up. Insignificant correlations were demonstrated between soluble (SDC-1) and the presenting complete blood count (CBC) parameters. CONCLUSIONS: Although the high level of plasma syndecan-1 was demonstrated in patients with AML compared to the control group, there was no significant difference with respect to age, FAB subtype, and type of response to treatment nor with the patient outcome, and also no significant association was established with any of the hematological parameters.

Electrocardiographic changes in dengue fever

Electrocardiographic changes in dengue fever

Traumatic intracranial aneurysms following combat damage

To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.

Upper Gastrointestinal Bleeding Induced by Gastric Ulcer Secondary to Strongyloidiasis: A Case Report.

gastric ulcer; gastrointestinal haemorrhage; Strongyloides stercoralis; strongyloidiasis.

Frequency and Clinical Significance of Antinuclear Antibody Positivity in Immune Thrombocytopenia in Adults

Background Immune thrombocytopenia is an immune-mediated disorder with heterogenous presentation. It shows association with other autoimmune disorders with varying frequency. Objective The objective of this study was to establish the frequency of antinuclear antibody (ANA) in our population and to evaluate its association with severity of clinical presentation, disease remission and association with other autoimmune diseases. Design Cross-sectional study. Methods This was a descriptive cross-sectional study that included 160 patients with immune thrombocytopenia purpura (ITP) presented at National Institute of Blood Disease and Bone Marrow Transplantation from February 2021 to July 2022. Patients were screened for ANA and other causes of secondary ITP. ANA-positive patients were compared with ANA-negative patients in terms of bleeding manifestations and platelet counts at initial presentation, association with other autoimmune diseases and response to first-line treatment. Results In our study 43 (26.9%) patients were ANA positive and 117 (73.1%) were negative for ANA. The initial platelet counts, and bleeding symptoms were not found to be significantly different among the 2 groups. And 79.1% of the ANA-positive patients had other autoimmune markers as well compared to 20.9% ANA-negative patients, showing a significant association ( P&lt;.001). Response to treatment with steroid ± azathioprine assessed at 3 and 6 months were similar in both the groups. Conclusion Our results demonstrate that ANA positivity is not associated with severity of presenting symptoms, initial platelet counts, or response to treatment. However, the presence of ANA is associated with increased risk of other autoimmune diseases in patients with ITP.

Effects of gastrointestinal endoscopy at different time points on diagnosis and treatment of upper gastrointestinal bleeding in patients with liver cirrhosis.

Liver cirrhosis is a common diffuse and persistent liver disease in the gastroenterology department. To assess the effects of gastrointestinal endoscopy at different time points on the diagnosis and treatment of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis. The clinical data of 102 liver cirrhosis patients with UGIB admitted from July 2020 to May 2022 were retrospectively analysed. According to the timing of the first gastroscopy after hospitalization, the patients were divided into 4 groups: Group A (n = 25, gastroscopy performed within 12 h of the first bleeding), Group B (n = 29, gastroscopy performed within 12-48 h of the first bleeding), Group C (n = 25, elective gastroscopy performed > 48 h after the first bleeding), and Group D (n = 23, emergency gastroscopy was conducted due to active bleeding manifestations after failure of medication). The success rate of haemostasis in Group A was higher than in Groups B-D (p < 0.05). The early rebleeding rates of the 4 groups were similar (p > 0.05). After treatment, the levels of serum malondialdehyde and lipid hydrogen peroxide declined but the levels of glutathione peroxidase and superoxide dismutase rose in all groups compared to those immediately after hospitalization (p < 0.05), and these indicators were improved more significantly in Group A (p < 0.05). Gastroscopy performed within 12 h of the first bleeding is more conducive to improving the haemostatic effect and thus shortening the length of hospital stay.

Thrombocytopenia and its Relationship with Bleeding Manifestations in Dengue Patients-A Tertiary Care Hospital Experience

Objective: To explore the extent of bleeding among three different groups of patients based on their blood platelet count and identify the frequency of specific types of bleeding manifestations among the study groups.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Pak-Emirates Military Hospital, (PEMH) Rawalpindi Pakistan, from Jul to Dec 2019.&#x0D; Methodology: One hundred patients hospitalized with dengue fever and platelet count of less than 100,000 per microliter of blood were enrolled in the study. They were divided into three groups based on platelet count, i.e., &lt;20,000 (Group-1), 20,000- 50,000 (Group-2), and &gt;50,000 (Group-3) per microliter of blood and observed for different types of bleeds and were also categorized as no bleed, single-site bleed and multiple-site bleed.&#x0D; Results: Group comparisons revealed that no patient from Group-1 versus 3(10.3%), patients from Group-2 whereas 11(19.3%) patients from Group-3 experienced single site bleed (p=0.05). In addition, patients belonging to Group-1 experienced significantly more petechiae as compared to Groups 2 and 3 (92.8% vs 65.5% vs 19.2%, p&lt;0.001). Similarly, gum bleeding and purpura were more commonly observed in Group-1 than in two other groups (50% vs 44.8% vs 14.0%, p 0.001; 85.7% vs 44.8% vs 3.5%, p&lt;0.001, respectively).&#x0D; Conclusion: Bleeding complications among dengue patients has a positive relationship with platelet count, but some specific bleeds, e.g., melena, hematemesis, hemoptysis and per vaginal bleed, cannot be directly correlated with the number of platelets circulating in the blood.

A perfect storm: acute portal vein thrombosis in a patient with severe dengue and hemorrhagic manifestations—a case report

BackgroundDengue constitutes a public health problem in endemic regions. The clinical course can range from asymptomatic to severe expressions. Hemorrhagic manifestations are the most frequently reported complications; on the contrary, thrombotic complications are unusual.Clinical caseWe present the case of an adult patient who presented hemodynamic instability, severe thrombocytopenia, and positive serology for dengue, in whom acute portal vein thrombosis was documented. The possible pathophysiology of thrombocytopenia and thrombosis in dengue is discussed, as well as the dilemmas regarding the treatment of associated hemorrhagic and thrombotic manifestations.ConclusionsThe present case brings up the importance of considering the possibility of thrombotic events in patients with severe dengue. A high degree of suspicion, close assessment of hemostatic function, and quality supportive care are essential to improve outcomes. To our knowledge, this is the first report of dengue-associated portal vein thrombosis.