Wijayaratne Dilushi, Ranasinghe Priyanga, Mohotti Shanaka P, Dilrukshi Shani Apsara, Katulanda Prasad
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
BMC Res Notes. 2015 Mar 12;8:78. doi: 10.1186/s13104-015-1043-x.
Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world. Haemophilia A is the commonest inherited bleeding disorder. There is little data on the incidence and outcome of dengue in patients with haemophila. We report a case of a patient with severe haemophila A, presenting with dengue fever, managed at a tertiary care hospital in Sri Lanka.
A 16-year-old Sinhalese male with severe haemophilia A (factor level < 1percent) was admitted to a teaching hospital in Sri Lanka on day 1 of an acute febrile illness, associated with arthralgia, myalgia, vomiting and headache. On admission, he had a tachycardia of 120 beats per minute, and blood pressure of 110/70 millimetres of mercury, with no bleeding manifestations. Baseline investigations revealed leukocyte and platelet counts of 4400 and 241,000 per cubic millimtre, respectively, and a haematocrit of 34.5 percent. Dengue was confirmed later by sero-conversion of the dengue IgM antibody test. Fluid balance, pulse rate and blood pressure were monitored hourly. The haematocrit and platelet counts were checked thrice daily, while he was clinically assessed for bleeding. On day 3 he developed bleeding from a tooth extraction site, with vomiting of dark red blood. His platelet level at that point was 124,000 per cubic millimetre with a haematocrit of 32 percent. Intravenous factor VIII was given to achieve a 100 percent factor correction over twenty-four hours. His platelet count dropped progressively from admission to a nadir of 50,000 per cubic millimetre on day 6. He did not develop clinical evidence of fluid leakage. On day 7 he was discharged after complete recovery.
People with haemophilia may exhibit bleeding from the early febrile stage and at higher platelet levels than most other patients with dengue. Further discussion and research is necessary to decide on the optimal management of these patients, with regard to monitoring and timely treatment with blood products and/or factor correction, in order to prevent dengue-related morbidity and mortality whilst avoiding overtreatment. In endemic areas it is advisable that such patients seek early medical help in the event of an acute fever.
登革热是世界上传播速度最快的蚊媒病毒性疾病。甲型血友病是最常见的遗传性出血性疾病。关于血友病患者登革热的发病率和预后的数据很少。我们报告一例患有严重甲型血友病的患者，其出现登革热，在斯里兰卡的一家三级医院接受治疗。
一名16岁的僧伽罗族男性，患有严重甲型血友病（因子水平<1%），在急性发热疾病的第1天被收治于斯里兰卡的一家教学医院，伴有关节痛、肌痛、呕吐和头痛。入院时，他的心率为每分钟120次，血压为110/70毫米汞柱，无出血表现。基线检查显示白细胞计数和血小板计数分别为每立方毫米4400和241,000，血细胞比容为34.5%。登革热后来通过登革热IgM抗体检测的血清转化得到确诊。每小时监测液体平衡、脉搏率和血压。每天检查三次血细胞比容和血小板计数，同时对其进行出血的临床评估。第3天，他拔牙部位出血，伴有暗红色血液呕吐。此时他的血小板水平为每立方毫米124,000，血细胞比容为32%。静脉注射凝血因子VIII，以在24小时内实现100%的因子校正。他的血小板计数从入院时开始逐渐下降，在第6天降至最低点每立方毫米50,000。他没有出现液体渗漏的临床证据。第7天，他完全康复后出院。
血友病患者可能在发热早期且血小板水平高于大多数其他登革热患者时出现出血。有必要进一步讨论和研究，以确定这些患者的最佳管理方案，包括监测以及及时使用血液制品和/或进行因子校正治疗，以预防登革热相关的发病率和死亡率，同时避免过度治疗。在流行地区，建议此类患者在出现急性发热时尽早寻求医疗帮助。
