Lecture 1: Clinical and Haematological Aspects of Dengue
Professor Lucy Lum Chai See, MBBS(UM)(1981), MRCP(UK)(1987), Faculty of Medicine, University Malaya, Malaysia
Lecture 2: Haematological Changes in Dengue Infection
Dr Kono Mari, PhD, Director, Scientific Affairs, Sysmex Corporation, Japan
Objectives of the Lectures
Dengue is a mosquito-borne viral disease, that potentially can result in severe complications and death. Infections are on the rise in 2020 in numerous Asian cities. Transmitted mainly by the Aedes aegypti, those infected may show symptoms, including high fever, severe headaches, muscle, and joint pains. Extreme cases can bring bleeding, breathing difficulties, organ failure, and potentially death. As patient conditions changes, there are significant shifts in haematological profiles from the routine blood test. In clinical research, there are significant correlations to the recovery phase. In this current webinar, we examine current clinical management guidelines and look at the patterns of change in haematological profiles. Our invited speakers are eminent clinician and scientist from Malaysia and Japan that has extensive experience on managing and researching Dengue infections. This highlights the critical need for better disease profiling that will aid clinical management using the routine blood test.
Abstracts of Talk
Dengue is one of the most important mosquito-borne diseases to affect humans worldwide, and of a major public health concern in the tropical and subtropical regions of the world. It continues to impose a major burden in healthcare systems. Dengue is a systemic and dynamic disease with symptoms ranging from undifferentiated fever to dengue shock syndrome. The vast majority of symptomatic dengue manifest in an uncomplicated disease course with severe dengue occurring in a small proportion of infections. The clinical course of dengue is closely related to the viraemic phase in the first 3 to 5 days of illness, followed by the hosts’ immune response phase. Concurrent with this pattern is the dynamic changes in hematological trends in peripheral blood. The phase of increased plasma leakage, one of the determinants of severity of disease during the immune phase of disease is preceded by a decrease in white cell counts and platelet counts. A recovery of white cell counts from leucopenia occurs just before the end of the critical phase. The period of thrombocytopenia lasts beyond the critical phase into the re-absorption phase of dengue. Clinicians observe for these hematological trends to navigate their patients through the dynamic phases of dengue and to administer appropriate supportive therapy. In this lecture we will introduce the various phases of the clinical course of dengue together with the hematological changes in the peripheral blood.
Sysmex haematology analyser provide not only CBC but also the optical information from scattergrams as research parameters. In this session, we will introduce some research parameters which are useful to grasp dengue pathology. Thrombocytopenia, one of the features of dengue, reported to occur by the bone marrow suppression at the infectious phase and the consumption of disseminated intravascular coagulation. Immature platelet fraction (IPF), which can be measured by the Sysmex XN-Series (XN), is an indirect indicator of platelet formation in the bone marrow. We will introduce using 287 patients data, about the possibility of that IPF can be utilised as an early recovery indicator of the platelet in the dengue patient with thrombocytopenia and as an early prognostic indicator for severe dengue in the early stage of dengue infection. Leukocytes have been reported to change their morphology when they encounter pathogens and to change their optical characteristics, thereby changing their position on the scattergram in haematology analyser. We will also introduce about the time course of optical parameters in leukocyte scattergram in XN.