Evaluation of Platelets as Predictive Parameters in Dengue Fever

Dengue is an arboviral disease and occurs in tropical countries where over 2.5 billion people are at risk of infection. 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. Severe thrombocytopenia and increased vascular permeability are two major characteristics of DHF. A study was conducted to note the relationship between the platelet counts and severity of the disease in pediatric cases of dengue fever. Platelet counts were found to be predictive as well as recovery parameter of DF/DHF/DSS.     

急性白血病患者输注血小板制剂的指征探讨

目的:探讨急性白血病患者输注血小板制剂的指征。方法:总结92例急性白血病患者在接受诱导缓解化疗、巩固化疗及强化治疗期间的出血表现、血小板计数变化及输注血小板情况。结果:接受诱导缓解化疗的急性白血病患者,出血倾向轻重不一,输注血小板的比例为31.5%;接受巩固化疗患者出血倾向较轻,输注血小板者比例为10.9%;接受中大剂量强化治疗的患者,出血倾向重,输注血小板比例为52.9%。结论:完全缓解后接受巩固及强化治疗的患者,如不伴发严重感染等加重出血的危险因素,可将血小板输注指征定为5×109/L;接受诱导缓解化疗,或接受巩固、强化治疗伴发严重感染的急性白血病患者,输注血小板指征可定为10×109/L或更高。     

Status of Platelet Collection and Platelet Transfusion

Abstract: Platelet product derived from single donor plateletpheresis is required to reduce the risks of adverse reactions by blood transfusion. The objectives of this study are to evaluate the status of platelet collection and its efficacy by various kinds of plateletpheresis equipment and to assess the achievement of platelet transfusion by platelet product derived from a single donor. Since the blood centers have introduced some kinds of efficient plateletpheresis equipment, large units of platelet products have been supplied mainly for the patients. Amicus and CCS might be preferable plateletpheresis machines because of their collection efficiencies and wider indication for donors. The average number of donors of platelet product per patient has recently reached nearly 1.0, and around 90% of patients have received platelet product derived from a single donor in the recent several years. However, platelet transfusion derived from a single donor has not yet been completely achieved. Each regional blood center should seriously consider the efficacy of each plateletpheresis equipment and arrange the equipment to collect platelets more effectively to achieve platelet transfusion from a single donor.     

云南省登革热流行病学调查分析

本对以往云南省登革热病原学、血清学和蚊媒调查资料进行了整理分析。从采自河口市的２９批雌性白纹伊蚊（Ａｅｄｅｓ ａｌｂｏｐｉｃｔｕｓ）中分离到登革４型病毒１株。从采自西双版纳地区（景洪、勐腊、勐海）的７２批２７２６只雌性白纹伊蚊中分离到登革病毒４株,其中４株３株,３型１株。批阳性率５．６％,现场感染比为１：６８２。本省２４个省、市人血清中登革ＣＦ抗体阳性率为１０．９１％（１８５／１６９６）,１５个     

Dengue fever and Kawasaki disease: a clinical dilemma

There are several pediatric conditions which can present with fever and rash; however, it is uncommon to have two diseases occurring in a patient at the same time. We report a young child with fever and rash. He was initially diagnosed to have dengue fever based on clinical features and serological tests. Later in the course of illness he developed findings consistent with Kawasaki disease. This is extremely unusual and has rarely been reported before.     

登革热的腹部超声表现

登革热（DF）是由登革热病毒引起，经伊蚊传播的急性传染病。广东省5月-11月是登革热发病的高峰期，近年有扩大流行的趋势。关于登革热的腹部超声表现目前国内较少有报道。本文对54例登革热患者进行常规的腹部超声检查，现报道如下。     

杭州市2019年登革病毒分子流行病学研究

目的 了解2019年杭州市登革病毒分子特征和可能的传播来源.方法 收集登革热患者血清样本,分析登革热流行特征.分别采用ELISA和RT-PCR方法检测登革热抗体、登革病毒核酸及其型别,再对核酸阳性样本进行E基因扩增、序列测定和进化分析.结果 2019年杭州共检测登革热病例212例(输入性病例158例,本地病例54例),...     

Evaluation of Efficacy in Platelet Collection by the Haemonetics Component Collection System

Abstract: Platelet concentrate product derived from plateletpheresis from a single donor is preferable in terms of reducing the risks of adverse reactions in platelet transfusion. This study evaluated the status of platelet transfusion and the efficacy and safety of plateletpheresis machines. The average number of donors of platelet product per patient has been decreasing and recently reached nearly 1.0; however, some patients still receive multiple random donor platelet products. Platelet collection efficacy was comparable between the Haemonetics Component Collection System (CCS) and the Multi Component System (Multi). However, the CCS has been shown to be effective in terms of processed blood volume and procedure time, especially in donors with lower hematocrits. These results suggest that the CCS may be preferable and safer for donors with lower hematocrits and lighter body weights. Blood centers should collect platelets more effectively to achieve platelet transfusion with the use of platelets derived from a single donor using effective equipment.     

登革热病人出血与心肌损害关系的分析

登革热可损害心肌。但登革热病人的出血与心肌损害有何关系未见报导。作者对此进行临床分析。结果，94例登革热病人有出血现象的（Ⅰ组）36例。无出血现象的（Ⅱ组）58例；94例有20例发生心肌损害，Ⅰ组12例，发生率为3333％，明显多于Ⅱ组的8例（发生率为13．79％），P＜0.05。Ⅰ组病人的心肌损害表现比Ⅱ组的稍重；心肌损害的恢复都在出血现象停止之后，最后全部治愈。     

First Isolation of Dengue Virus from the 2010 Epidemic in Nepal

Dengue is an emerging disease in Nepal and was first observed as an outbreak in nine lowland districts in 2006. In 2010, however, a large epidemic of dengue occurred with 4,529 suspected and 917 serologically-confirmed cases and five deaths reported in government hospitals in Nepal. The collection of demographic information was performed along with an entomological survey and clinical evaluation of the patients. A total of 280 serum samples were collected from suspected dengue patients. These samples were subjected to routine laboratory investigations and IgM-capture ELISA for dengue serological identification, and 160 acute serum samples were used for virus isolation, RT-PCR, sequencing and phylogenetic analysis. The results showed that affected patients were predominately adults, and that 10% of the cases were classified as dengue haemorrhagic fever/ dengue shock syndrome. The genetic characterization of dengue viruses isolated from patients in four major outbreak areas of Nepal suggests that the DENV-1 strain was responsible for the 2010 epidemic. Entomological studies identified Aedes aegypti in all epidemic areas. All viruses belonged to a monophyletic single clade which is phylogenetically close to Indian viruses. The dengue epidemic started in the lowlands and expanded to the highland areas. To our knowledge, this is the first dengue isolation and genetic characterization reported from Nepal.     

Platelet Indices and Their Kinetics Predict Mortality in Patients of Sepsis

Platelet indices are inexpensive, easily accessible parameters and potentially useful prognostic indicators in sepsis. In this study we explore the differences in platelet indices and their kinetics between sepsis survivors and non-survivors. A retrospective cohort-study of 97 cases of culture-positive sepsis at a tertiary-care center in North India. Demographics, clinical and laboratory parameters at admission were assessed. Platelet count (PLT), mean-platelet-volume (MPV), platelet-distribution-width (PDW) and plateletcrit (PCT) on admission, and third, fifth and last days of hospitalization were analyzed. Fractional change in platelet indices (ΔMPV_72h, ΔPDW_72h, ΔPCT_72h, and ΔPLT_72h) by day-3 were calculated. Unpaired and paired t-tests were used to compare survivors with non-survivors, and to study the change in platelet indices with time. Logistic regression was used for multivariate analysis. ROC-curves and optimum cut-offs to predict mortality were obtained. There were 64 survivors. Non-survivors had significantly higher ΔMPV_72h, ΔPDW_72h, day-1 MPV and PDW, and lower ΔPLT_72h. MPV and PDW increased, and PLT decreased with time among non-survivors. Trends were reversed in survivors. Only MPV and PDW showed significant change by day-3. Both were independent predictors of mortality on multivariate analysis, alongside ΔMPV_72h and ΔPLT_72h. On ROC analysis, MPV, PDW, ΔMPV_72h, ΔPDW_72h and ΔPLT_72h effectively predicted mortality. Cut-off for MPV was 10.25 fL (sensitivity = 93.9%, specificity = 60.9%), and PDW, 12.6% (sensitivity = 84.8%, specificity = 51.6%). A rise in MPV and a fall in PLT was associated with mortality in this study. MPV and PDW values at admission are effective predictors of mortality and may be used in conjunction with traditional parameters.     

福建省莆田市2007年登革热暴发的流行病学调查分析

目的调查分析2007年福建省莆田市登革热暴发的流行病学特征、影响因素,并对病原体的可能来源进行追踪。方法利用流行病学调查和疫情报告数据以及病毒分离株的序列信息,分析、阐明暴发的流行学特点及影响因素;从感染者体内分离病毒并进行病毒序列测定,分析本次暴发可能的病毒来源。结果本次暴发为登革II型病毒引起的登革热暴发流行。共报告确诊病例103例,波及5个乡镇,发病主要集中在9月8日-10月8日,多数病例发生在1-2个村(街道),发病具有时间和空间的聚集性特征,病例临床表现均为典型登革热特征,无临床严重或死亡病例。从病毒分离株的序列分析表明,导致暴发的病毒来源可能为东南亚。外界病毒传入、高白纹伊蚊密度和临床漏诊可能是导致该起登革热暴发流行的主要原因。结论本次暴发流行为一起由输入性病例引起,在当地扩散造成的登革II型病毒暴发,病毒的来源可能是东南亚一带。     

Regional Differences in the Growing Incidence of Dengue Fever in Vietnam Explained by Weather Variability

Dengue fever is a major health problem in Vietnam, but its incidence differs from province to province. To understand this at the local level, we assessed the effect of four weather components (humidity, rainfall, temperature and sunshine) on the number of dengue cases in nine provinces of Vietnam. Monthly data from 1999 to 2009 were analysed by time-series regression using negative binomial models. A test for heterogeneity was applied to assess the weather-dengue association in the provinces. Those associations were significantly heterogeneous (for temperature, humidity, and sunshine: P < 0.001 heterogeneity test; for rainfall: P = 0.018 heterogeneity test). This confirms that weather components strongly affect dengue transmission at a lag time of 0 to 3 months, with considerable variation in their influence among different areas in Vietnam. This finding may promote the strategic prevention of dengue disease by suggesting specific plans at the local level, rather than a nationally unified approach.     

Dengue hemorrhagic fever and the liver

Dengue hemorrhagic fever (DHF) is one of the most rapidly emerging infections of tropical and subtropical regions worldwide. It affects more rural and urban areas due to many factors, including climate change. Although most people with dengue viral infection are asymptomatic, approximately 25% experience a self-limited febrile illness with mild to moderate biochemical abnormalities. Severe dengue diseases develop in a small proportion of these patients, and the common organ involvement is the liver. The hepatocellular injury was found in 60%-90% of DHF patients manifested as hepatomegaly, jaundice, elevated aminotransferase enzymes, and critical condition as an acute liver failure (ALF). Even the incidence of ALF in DHF is very low (0.31%-1.1%), but it is associated with a relatively high mortality rate (20%-68.3%). The pathophysiology of liver injury in DHF included the direct cytopathic effect of the DENV causing hepatocytes apoptosis, immune-mediated hepatocyte injury induced hepatitis, and cytokine storm. Hepatic hypoperfusion is another contributing factor in dengue shock syndrome. The reduction of morbidity and mortality in DHF with liver involvement is dependent on the early detection of warning signs before the development of ALF.     

澳门老年登革热患者156例临床分析

目的 分析澳门地区老年登革热病患者的临床特点。方法 回顾性分析澳门镜湖医院2001年8～12月间156例老年登革热住院患者的临床资料。结果 老年登革热以发热、疼痛、皮疹为主要临床症状。实验室检查提示白细胞减少,血小板减少、丙氨酸转氨酶升高发生率分别为83.3％和64.7％,较非老年患者的54.9％和27.6％为高。老年组并发症27例(17.4％),较非老年组6例(2.2％)多,差异有显著性(P<0.01) 结论 老年登革热的临床病情较严重,并发症较多。     

Platelet count, mean platelet volume, platelet distribution width, and plateletcrit do not correlate with optical platelet aggegation responses in healthy volunteers

Background Recent advances in technology have made it possible to record various platelet indices. There have been many reports about platelet indices and platelet disorders. The aim of this study is to investigate whether anatomical indices have a correlation with functional aggregation responses using optical method in healthy adults and to evaluate the predictive significance of platelet indices over platelet aggregation responses.Methods This study was carried on 31 adults whose ages ranging between 20 and 42. Platelet parameters, including platelet count, mean platelet volume, platelet distribution width and plateletcrit were determined in platelet rich plasma using Abbott Cell-Dyn 4.000. Platelet aggregation was induced by adenosine diphosphate, collagen and epinephrine. Optical aggregation was performed using a turbidometric method.Results We have observed no correlation between any of platelet indices measured and platelet aggregation responses.Conclusions As a result, we found no correlation between platelet aggregation responses obtained with optical method and platelet indices proposed as indicators of certain pathologic conditions, and it does not seem possible to use platelet indices as a direct indicator of platelet activation. In conditions where platelet functions should have been assessed, platelet indices alone are inappropriate and further evaluation is necessary with different methods.     

Prophyactic Platelet Transfusion in Stable Dengue Fever Patients: Is It Really Necessary?

Our hospital is a referral centre for Jehovah’s Witnesses (JW) patients, who as a matter of religious belief refuse transfusions of blood/blood components. We have treated JW patients with dengue fever (DF) and thrombocytopenia without platelet transfusion, without any mortality or major morbidities. We retrospectively compared the duration needed for platelet recovery and duration of hospitalization of DF with thrombocytopenia in those treated with prophylactic platelet transfusion and JW patients who were managed without these. Among JW patients, platelet counts recovered to >50,000 in 2.57 days (Mean) as compared to those who received prophylactic platelet transfusion, who recovered in 4.43 days (P value < 0.0001). They also had significantly less number of days of hospitalization (3.68 days vs 5.13 days, P value < 0.0001). These differences persisted even when a subgroup analysis of patients who had nadir platelet count less than 10,000 were done. Most importantly, none of the patients in either group suffered any significant morbidity or mortality. Prophylactic platelet transfusion in clinically stable DF patients was associated with significant delay in platelet recovery and increased duration of hospitalization, even though was not harmful in terms of morbidity or mortality. Though number of subjects involved in the study was small, this brief report further adds to the current evidence that prophylactic platelet transfusion in clinically stable DF patients with a platelet count more than 10,000/cmm is not indicated.     

用硫酸鱼精蛋白从HFRSV感染材料中提取病毒蛋白及鉴定

本文采用硫酸鱼精蛋白沉淀方法，从感染肾综合征出血热病毒（HFRSV）的鼠脑和细胞中提取病毒蛋白，结果表明：鼠脑先后用鱼精蛋白1mg／ml和2mg／ml两次沉淀HFRSV蛋白时，细胞先后用鱼精蛋白4mg／ml和2mg／ml两次沉淀HFRSV蛋白时，效果均较好。SDS－PAGE电泳显示：提取的病毒蛋白分子量为67kD、55kD、45kD。Western－Blotting及ELISA表明：提取的病毒蛋白为病毒的特异性蛋白。血凝试验表明：从鼠脑及细胞中提取的病毒蛋白血凝效价分别为1：1024、1：4096。液闪计数可观察到[3H]-氨基葡萄糖只结合入了67KD和55kD两种蛋白。     

70例登革热并发肝损伤患者临床特征和预后因素分析

目的 总结登革热(DF)并发肝损伤的临床特点。方法 2019年1～12月广东省第二人民医院收治的70例DF患者,给予DF患者对症处理,给予肝损伤患者甘草酸类护肝、降酶和对症处理。总结分析临床资料,包括血液和血生化指标。结果 在70例DF患者中,主要症状有发热、关节痛、皮疹、腹痛、腹泻、呼吸道和泌尿道感染,外周血白细胞降低者34例,血小板计数降低者35例,血生化异常33例;33例肝功能损伤患者住院时间为(7.1±2.2)天,显著长于37例无肝损伤患者【(5.8±2.0),P<0.05】,70例DF患者经治疗后均治愈出院,无死亡病例;肝损伤与无肝损伤患者外周血白细胞计数无显著性差异(P>0.05),但肝损伤患者血小板计数为(105.0±48.6)×10⁹/L,显著低于无肝损伤组【(156.2±88.7)×10⁹/L,P<0.05】;肝损伤组血生化指标主要表现为血清ALT、AST、GGT、CRP和CK-MB水平轻度升高,但均恢复良好。结论 DF患者可能并发肝损伤,但总体肝损伤程度轻,护肝降酶效果好,恢复快。