International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

Role of Platelet Parameters in Dengue Positive Cases - An Observational

Study
Navya B.N1, Shwetha Patil2, T.M. Kariappa3
1
Associate Professor, 2Post Graduate, 3Professor & HOD,
Department of Pathology, K. V. G. Medical College & Hospital, Sullia. D. K, Karnataka, India
Corresponding Author: Navya B.N.

Received: 05/05/2016 Revised: 19/05/2016 Accepted: 23/05/2016

ABSTRACT

Background: Dengue is an endemic disease in subtropical and tropical regions of the world causing
severe epidemic in India and is endemic in many parts of India, especially the metropolitan cities and
towns. Each year an estimated 100 million cases of dengue fever (DF) occur and between 2.5 and 5
lakh cases of dengue hemorrhagic fever (DHF) are reported to WHO.
Aim and Objectives: To study the role of platelet parameters like platelet count (PLT), Mean
platelet volume (MPV) and Platelet distribution width (PDW) in dengue positive infection and also to
note their relationship with the severity of the disease.
Material and Methods: The study was done on 100 dengue positive cases during the outbreak of
dengue infection over a period of 6 months between May 2015 to October 2015. The platelet
parameter like Platelet count, Mean platelet volume, Platelet distribution width were noted using BC
3000 plus Mindray Automated Hematology Analyzer and was compared with severity of disease
(DF/DHF/DSS).
Results: Relationship between platelet parameters like platelet count, MPV and PDW were made
with severity of the disease (DF/DHF/DSS). Significant difference was observed between severity of
the thrombocytopenia and severity of the disease (P value - 0.013). Dengue positive cases were
associated with low MPV and high PDW values in 72% cases and 92% cases respectively.
Conclusion: Platelet count is thus a predictive parameter of DF/DHF/DSS. Low MPV (<9fl) and high
PDW (>13fl) shows sensitivity for dengue fever thus reflecting a predictive marker for diagnosing
dengue fever in endemic area.

Key words: Dengue, MPV, PDW.

INTRODUCTION dengue hemorrhagic fever/ dengue shock

Dengue is the most important syndrome which is fatal. {3} Detection of
merging tropical viral disease in the world dengue specific IgM/IgG has been the
today. Dengue is caused by one of the four mainstay of diagnosis of dengue infection
serotypes of the dengue virus (DEN-1,DEN- (DI). Antibody detection is an indirect
2,DEN-3,DEN-4) also referred to as an method of diagnosis and, therefore, is prone
arbovirus (arthropod-borne viruses) that to false positive as well as false negative
belongs to the genus flavivirus of the family results. Of late, non structural protein 1
flaviviridae. It is transmitted by mosquitoes (NS1) detection is available for diagnosis of
of the genus Aedes aegypti. {1,2} It produces DF. NS1Ag detection is reported to be
two types of diseases- one mild self limiting sensitive as well as highly specific. Apart
illness that is dengue fever and the other is from the dengue specific parameters,

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platelet count is the only accessory K.V.G Medical college and hospital sullia,
laboratory test available in the peripheral D.K.
areas that can support the diagnosis of DHF The platelet parameters of 100
or DSS. Even in remote areas, platelet dengue positive patients like Platelet count,
counts can be roughly estimated by Mean platelet volume, Platelet distribution
microscopy. {4} The complex mechanism of width were noted using BC 3000 plus
thrombocytopenia remains unclear. Mindray Automated Hematology Analyzer
Recently, novel platelet indices such as and were compared with severity of the
MPV and PDW have been investigated as disease which included DF/DHF and DSS.
prospective platelet activation markers. {5} Inclusion criteria: All patients with clinical
The aim of our study was to features and serologically positive dengue
investigate the platelet parameters and to infection were included.
assess the role of it in dengue positive Exclusion criteria: Patients serologically
infection and also to note their relationship negative for dengue infection and if routine
between the platelet count and the severity laboratory testing suggested a bacterial,
of the disease in the tertiary care setup. parasitic or any viral infection other than
Objective: To study the role of platelet dengue infection or any other disease were
parameters like platelet count, PDW and excluded from the study.
MPV in dengue positive infection and also Statistical analysis
to note their relationship with the severity of Data was entered in Microsoft
the disease. Office Excel 2007 and analysis done using
SPSS (version 16) windows.
MATERIALS AND METHODS
This was an observational study RESULTS
carried out in a tertiary care hospital on all A total of 100 cases were studied,
dengue positive cases during the outbreak of based on positive dengue test. Platelet
dengue infection over a period of 6 months parameters like platelet count, MPV and
between May 2015 to October 2015, in the PDW of these patients were assessed by
Department of Pathology and Microbiology using BC Plus Mindray Automated
hematology analyzer.
Table 1: Total no. of patients in age group
Serial No. Age in Group Male Female Total No. of Patients Percentage
1 0 - 20 10 14 24 24%
2 21 - 40 22 18 40 40%
3 41 - 60 12 24 36 36%
Total 44 56 100 100%

Of these 44 were males, 56 were is a rapid visual test for dengue. 90 patients
females. Patients were mainly in age group were positive for NS-1, 8 patients were
of 21-40years (40%) followed by 41-60 positive for IgG and none for IgM. Only
years (36%), 0-20 years (24%). (Table 1) two patients were positive for all NS-1, IgM
Table 2: Dengue Positive cases
and IgG.
Dengue Parameters No. of positive cases Platelet counts results were grouped
NS1 positive 90 under 4 groups <20,000, 21-50,000, 50,000-
IgG positive 8
IgM positive 0 1, 00,000 and >1 lakhs. Of the patients with
Both NS1 and IgG positive 0 thrombocytopenia (i.e. platelet count < 1
Both IgG and IgM positive 0
Both NS1 and IgM positive 0
lakh) 8 patients had platelet count <20,000
All positive 2 (sever thrombocytopenia) 16 patients had
Total 100 platelet count between 21,000- 50,000
Of all the positive samples tested by (moderate thrombocytopenia), 16 patients
antigen - antibody reaction principle which had platelet count between 51,000-1 lakh

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(mild thrombocytopenia) while remaining among different age group. Chi square was
cases in our study had platelet count > 1 done and p value was found to be 0.991
lakhs (60 cases). There was no significant which signifies that, it is not statistically
difference in severe thrombocytopenia significant.
Table 3: Platelet count with age wise distribution
Age Group Platelet counts
<20,000 21,000-50,000 51,000-1 lakh >1 lakh Total
0-20 1(7,1%) 3(21.4%) 4(28.5%) 6(42.8%) 14(100%)
21-40 2(8%) 6(24%) 4(16%) 13(52%) 25(100)
41-60 5(8.1%) 7(11.1%) 8(13.1%) 41(67.2%) 61(100%)
Total 8(8%) 16(16%) 16(16%) 60(60%) 100(100%)

Table 4: Platelet count with severity of disease

Platelet Count DF DHF DSS Total
<20,000 10(71.40%) 4(28.57%) 0(0%) 14(100%)
21,000 to 50,000 20(83.33%) 4(16.66%) 0(0%) 24(100%)
51000 to 1,00,000 40(95.2%) 2(4.76%) 0(0%) 42(100%)
>1 lakh 20(100%) 0(0%) 0(0%) 20(100%)
90(90%) 10(10%) 0(0%) 100(100%)

The seropositive patients were while 100% were of DHF remaining 28%
followed clinically for the symptoms of cases showed high MPV (>9fl). A high
DHF/DSS and they were correlated with the PDW (>13fl) which indicates as useful
respective platelet counts. Dengue fever marker for platelet activation was seen in
(DF) cases were noted in 90 cases and 92% 0f cases, of which 84 cases were DF
dengue hemorrhagic fever (DHF) cases while 8 cases were DHF remaining 8% of
were noted in 10 cases. Among the 90 cases cases showed low PDW (<13fl).
of DF about 40 cases had mild
thrombocytopenia followed by moderate DISCUSSION
thrombocytopenia in 20cases and severe DF is a self limited febrile illness;
thrombocytopenia in 10 cases while DHF is characterized by prominent
remaining 20 cases had platelet count > 1 haemorrhagic manifestations associated
lakh. Among 10 cases of DHF, 2 cases had with thrombocytopenia and an increased
mild thrombocytopenia, 4 cases had vascular permeability. The clinical
moderate thrombocytopenia and remaining diagnosis of DHF especially in the early
4 cases had severe thrombocytopenia. In our phase of illness is not easy. Laboratory
study, no case of DSS was seen. Significant findings such as thrombocytopenia and a
difference was observed between severity of rising hematocrit in DHF cases are usually
the thrombocytopenia and severity of the observed by day 3 or 4 of the illness. {5} The
disease, (P value -0.013) complex mechanism of thrombocytopenia
Table 5: Platelet indices with severity of disease in dengue
remains unclear. Possible mechanisms of
positive cases thrombocytopenia could be, direct bone
Diagnosis Low MPV High MPV Total marrow suppression by the virus; anti-
(<9fl) (>9fl)
DF 62(68.8%) 28(31.1) 90(100%) dengue antibody-mediated platelet
DHF 10(100%) 0(0%) 10(100%) destruction, peripheral consumption of
Total 72(72%) 28(28%) 100(100)
Low PDW High PDW Total platelets and isolated viral replication in the
(<13fl) (>13fl) platelet. {6} Thrombocytopenia (TCP) can be
DF 6(6.66%) 84(93.33) 90(100%)
DHF 2(20%) 8(80%) 10(100%)
due to increased peripheral destruction,
Total 8(8%) 92(92%) 100(100%) inadequate production or abnormal pooling.
{7}
The release of high levels of platelet-
Among 100 dengue positive cases, activating factor may induce platelet
low MPV (<9fl) which indicates bone consumption and augment adhesiveness of
marrow suppression was seen in 72% of the vascular endothelial cells resulting in
cases, of which 68% were diagnosed as DF thrombocytopenia. {1} Thrombocytopenia

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leads to bleeding although the platelet count and severity of the disease (P value -0.013).
may not directly correlate with the bleeding Platelet count is thus a predictive parameter
manifestation recently, novel platelet of DF/DHF/DSS. Low MPV (<9fl) and high
indices such as MPV and PDW have been PDW (>13fl) shows sensitivity for dengue
investigated as prospective platelet fever thus reflecting a predictive marker for
activation markers. Platelet volume, a diagnosing dengue fever in endemic area.
marker of platelet function and activity is Limitation: Small sample size and study
measured as mean platelet volume (MPV) restricted to small geographic area are
by hematology analyzers. MPV can be used considered as two important limitations of
as independent predictors of bleeding. It is our study.
surrogate marker of bone marrow activity; a Recommendation: Further research studies
high MPV indicates increased in endemic areas are needed to support and
megakaryocyte activity. A low MPV asses the real benefits of our findings in
indicates marrow suppression and increased wider population.
risk of bleeding. Correlation of platelet
count and MPV with bleeding and severity REFERENCES
of the disease can potentially predict 1. Dongre T, Karmarkar P; Hematological
outcome. {6} The present effort for finding Parameters and Its Utility in Dengue-A
simple and widely used platelet activation Prospective Study, JDMS, 2015; 14(2):
indices focused on the fact that platelet 31-34.
2. Mehboo R, Munir M, Azeem A, Naeem
activation causes morphologic changes of S, Tariq AM, Ahmad JF; Low Platelet
platelets, including both the spherical shape Count Associated with Dengue
and pseudopodia formation. Platelets with Hemorrhagic Fever, IJAC, 2013;1:29-
increased number and size of pseudopodia 34.
differ in size, possibly affecting platelet 3. Benachinmardi KK, Panduranga C,
distribution width (PDW). {8,9} srinivasamurthy, Burugina NS, Vani
According to the study conducted by B.R, Navaneeth. B.N; Hemotological
Jayashree K et al there was a significant profile in acute dengue infection: A
association between platelet counts and study at tertiary care teaching hospital, J
severity of the disease which is similar to Pharma Biomed Sci. 2013;
our study, thus concluding that platelet 36(36):1866-1870.
4. Aruna R, Prakash M; A comparative
count can be used as predictive parameters study on Dengue Virus infection:
for diagnosing DF/DHF/DSS. {5} Serological markers Vs Platelet count,
Similar study was done by Bashir Int. J Curr. Rev. Aca. Rev. 2014;
AB et al on control and study group and 2(12):232-235.
found that the MPV was decreased in cases 5. Jayashree K, Manasa P; Evaluation of
of study group that is dengue positive cases platelets as predictive parameters in
and was normal in cases of control. PDW dengue fever, Indian Journal of Hematol
was normal in control group while it was Blood Transfus, 2011; 27(3):127-130.
increased in dengue infection, {6} which is 6. Bashir AB, Saeed OK, Mohammed BA,
accordance with our study. Since our study Ageep AK; Role of Platelet Indices in
was an observational study only dengue Patients with Dengue Infection in Red
Sea State, Sudan, IJSR,2013;6(14):
positive cases were taken and control group 1573-1576.
were not included. 7. Reddy SR, Khan IM, Phansalkar DM;
Platelet Distribution Width (PDW) in
CONCLUSION Thrombocytopenia, Indian Medical
The study focuses the importance of Gazette, 2015: 169174.
platelet parameters in dengue infection. 8. Platelet distribution width: a simple,
Significant difference was observed practical and specific marker of
between severity of the thrombocytopenia

International Journal of Health Sciences & Research (www.ijhsr.org) 77

Vol.6; Issue: 6; June 2016
 activation of coagulation, Hippokratia, bleeding manifestation among patients
2010; 14(1):28-32. with dengue virus infection in port
9. Bashir AB, Saeed OK, Mohammed BA, Sudan, Red sea state of Sudan, J. Infect.
Ageep AK; Thrombocytopenia and Dis. Immun. 2015; 7-13.

How to cite this article: Navya BN, Patil S, Kariappa TM. Role of platelet parameters in dengue
positive cases - an observational study. Int J Health Sci Res. 2016; 6(6):74-78.

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