Hyperferritinemia in Dengue Fever-Correlation between Serum Ferritin and Thrombocytopenia

Abstract

Introduction: Dengue fever is a widely prevalent viral infection in the tropical countries. Many patients with dengue fever are known to have severe cytopenias and the mechanism for the same is not known. Macrophage Activation Syndrome (MAS) is a life threatening complication that is known to be triggered by viral infections. This study attempts to examine the possibility of MAS as an underlying cause of cytopenias in dengue fever. Hyperferritinemia which is an important diagnostic criteria for MAS is known to occur in dengue fever also. Aim: The primary objective of the study was to assess the correlation between ferritin levels and mean platelet drop among patients admitted with dengue fever. Secondary objective was to do a subgroup analysis and compare the patients treated according to WHO standard protocols in dengue fever with those who were also given steroids and compare outcomes. Materials and Methods: This was a retrospective study done over a period of 18 months. Patients with dengue fever who satisfied the criteria for MAS were selected and the mean change in platelet count between the time of admission and 48 hours later was calculated. This was compared with the ferritin levels. Subgroup analysis was also done and the groups were correlated on two important clinical outcomes-the mean platelet drop and length of stay in hospital. Results: Total of 26 patients were enrolled in the study (n=26), of whom 18 (69.2%) were male. Pearson’s correlation coefficient (-0.231) was calculated to compare Ferritin levels with mean platelet drop and it showed that there was no correlation. There was no difference between the two groups with respect to mean platelet drop (p=0.08) and length of stay (p=0.443) in hospital. Conclusion: Hence, it can be concluded that hyperferritinemia does not correlate with the severity of platelet drop. There was no significant change in outcomes in patients with dengue fever associated MAS who were treated with steroids or with only standard treatment protocol.

Keywords

• autoimmunity
• haemophagocytic lymphohistiocytosis
• macrophage activation syndrome
• steroids
• tropical fever