HEMATOLOGICAL PARAMETERS IN DENGUE FEVER.

day 1-3, HCT levels of of DF (70.83%) of patients, and levels. Difference in HCT levels of of different types of dengue statistically On day 4-6, HCT levels of majority of DF (60.42%) of DHF (56.00%) and of both of DSS Difference in HCT levels of patients of different types of dengue be significant. On Day 7-9, HCT levels were normal among majority of DF (72.97%) and 38.46% of DHF patients. Low HCT levels were observed in majority of DHF (61.54%) and 21.62% of DF patients. Only 5.41% had raised HCT levels. Difference in HCT levels of patients in different types of dengue was not found to be statistically significant. On Day 10-12, HCT levels of majority of overall (61.22%) as well as DF (62.07%) and DHF (57.89%) were in normal range. The same pattern of haematocrit been observed in similar studies. In a study by Dhooria et (2008) rise of haematocrit (>40%) was found in 35.5% patients In the study by et that haematocrit of >40% was seen in 41.25%, 30-40% in 53.75 % patients. In Rajesh deshwal et al raised hematocrit (>45%) was noted in 20.77% of patients at presentation[3]. difference in observation for incidence of high haematocrit can be due to early of that haematocrit levels do


Results:-
A total of 75 patients of dengue fever were admitted in the Department during the period of study. Out of these 75 patients, majority were diagnosed as DF (64.00%), only 2 (2.67%) were diagnosed as DSS and rest 25 (33.33%) were diagnosed as DHF. Hemoglobin levels were found to be lower in maximum population during 4-6 day of fever and was significantly lower in DHF group of diseased population. The reason was hemodilution due to plasma leakage and hemorrhagic tendencies in DHF whose maximum incidence is during 4-6 day of fever. Hemoglobin levels at Day 1-3 were found to be lower in 35.82% population whereas it increased to 47.22% of population on day 4-6. Thereafter the incidence of low haemoglobin level decreased on day 7-10 and day 10-12. 1250 On day 1-3, HCT levels of majority of DF (60.98%) were normal, of DHF (70.83%) were low. Out of 2 DSS patients, 1 had normal HCT levels and 1 had high HCT levels. Difference in HCT levels of patients of different types of dengue was found to be statistically significant.
On day 4-6, HCT levels of majority of DF (60.42%) were normal and 11 patients i.e. (22.9%) of dengue fever had high hematocrit. In DHF (56.00%) were low and both patient of DSS were raised. Difference in HCT levels of patients of different types of dengue was found to be statistically significant.
On Day 7-9, HCT levels were normal among majority of DF (72.97%) and both patient of DSS has high hematocrit Low HCT levels were observed in majority of DHF (61.54%) and 21.62% of DF patients. Difference in HCT levels of patients in different types of dengue was not found to be statistically significant.
On Day 10-12, HCT levels of majority of overall (61.22%) as well as DF (62.07%), DHF (57.89%) and both patients of DSS were in normal range. None of the DHF and DSS patients and only 6.90% DF patients had raised HCT, rest of the DF (31.03% and DHF (42.11%) patients had below normal HCT. Difference in HCT levels of patients in different types of dengue was not found to be statistically significant. Neutrophil counts of majority of overall patients (85.33%) as well as DF (87.50%), DHF (80.0%) and both patients of DSS were below normal and rest of them had normal neutrophil levels. None of them had raised neutrophil levels. Difference in Neutrophil counts of DF, DHF and DSS patients was not found to be statistically significant.
Lymphocyte counts of majority of overall patients (57.33%) as well as DF (60.42%), DHF (52.0%) and one of the patients of DSS were normal, 15 DF and 8 DHF and one of the patient of DSS had high lymphocyte counts and rest of the DF (8.33%, DHF (16%) and one of the patient of DSS had low lymphocyte counts. Difference in Lymphocyte counts of DF, DHF and DSS patients was not found to be statistically significant.
Eosinophil counts of majority of overall patients (97.33%) as well as DF (97.92%), DHF (96.00%) and both patient of DSS were within normal range and rest of them had raised eosinophil counts. None of them had low eosinophil counts. Difference in Eosinophil counts of DF, DHF and DSS patients was not found to be statistically significant.
Mean monocyte counts among DHF (1.36±0.49) were found to be higher than that among DF (1.25±0.79) and DSS (1.00±0.00) but this difference was not found to be statistically significant (p=0.690).
Difference in mean basophil count of DF (0.27±0.54), DHF (0.44±0.58) and DSS (0.50±0.71) patients was not found to be statistically significant. At day 1-3, all the patients except 2 (8.33%) DHF patients had TPC counts below normal levels (<1.5 lakh) and rest had normal TPC count. Association of TPC count and type of dengue was not found to be statistically significant.
At day 4-6, all the patients except 2 (4.17%) DF patients had TPC counts below normal levels (<1.5 lakh) and rest had normal TPC count. Association of TPC count and type of dengue was not found to be statistically significant.
At day 7-9, all the patients had TPC counts below normal levels (<1.5 lakh).
At day 10-12, all the patients except 5 (15.63%) DF and 1 (5.26%) DHF patients had TPC counts below normal levels (<1.5 lakh) and rest had normal TPC count. Association of TPC count and type of dengue was not found to be statistically significant.

Discussion:-
Out of the total 75 patients studied during study period various hematological parameters were studied like haemoglobin, hematocrit, total leucocyte count, lymphocyte count, differential leucocyte count, total platelet count, and mean corpscular volume during 1 to 3, 4 to 6, 7 to 9 and 10 to 12 days after the days of onset of fever or constitutional symptoms. These parameters also compared between three types of dengue fever, DF, DHF and DSS.
It is important to know the mechanism of thrombocytopenia in dengue in order to design appropriate intervention. While hemophagocytosis or bone marrow suppression are possible explanations, we propose that endothelial sequestration of platelets could be the dominant mechanism of thrombocytopenia in patients with severe dengue. Endothelial sequestration is caused by platelet adherence to von Willebrand factor (vWF), expressed on vascular endothelial cells. Increased vWF expression, if associated with a significant reduction in its rate of cleavage, may result in increased expression on endothelial surfaces of ultra-large (uncleaved) vWF multimers, which avidly entrap platelets. This sequence would lead to two downstream effects: platelet plugs in the microcirculation and low platelet counts in peripheral blood. Microcirculatory platelet plugs within an organ can lead to organ failure. In the current study thrombocytopenia was mainly seen on day 4-6 of fever when fever starts subsiding. At day 4-6, 95.8% of DF patients and 100% of both DHF and DSS had thrombocytopenia, although association of TPC count and type of dengue was not found to be statistically significant. Similarly at day 7-9, all the patients had TPC counts below normal levels (<1.5 lakh). But at day 10-12 this proportion fall down to 84.3% in DF and 94.7% in DHF. In cases of dengue fever, a high hematocrit is a danger sign of an increased risk of dengue shock syndrome. Hemoconcentration can be detected by an escalation of over 20% in hematocrit levels that will come before shock. It