Enhanced fibrin-lysis in grade-1 dengue haemorrhagic fever

Background: Dengue fever has become a major international health concern affecting especially tropical and sub-tropical regions worldwide. The pathophysiology of dengue haemorrhagic fever is complex which involve endothelial activation and plasma leakage. The objective of the study was to determine endothelial activation and plasma leakage effects on fibrin-lysis in Grade-1 dengue haemorrhagic fever. Method: Twenty-two patients (Males n = 14, females N = 8) with Grade-1 DHF who fulfilled the WHO protocol for dengue were recruited. Their mean age was 22.5 ±12.2 years and ranged between 4 years and 54 years old. Blood sampling was performed at febrile, defervescence and convalescence phases for the determination of fibrinogen, Von Willebrand Factor (VWF), vascular endothelial growth factor (VEGF), prothrombin fragment 1+2 (F+2) and D-dimer levels. Fifteen normal subjects were recruited to serve as normal controls. Results and Discussion: There were no statistical differences observed between defervescence and convalescence phases compared with febrile phase for F1+2, D-dimer, VEGF, VWF and fibrinogen. At febrile phase elevated VEGF and VWF levels suggest endothelial activation and plasma leakage triggering the activation of coagulation and thrombin generation evident by increased F1+2 levels and fibrinolysis by marked fibrin lysis split product D-dimer. The levels remain elevated even at defervescence and convalescence phases. Fibrinogen levels showed a mean decline trend but remained within normal range. Conclusion: In Grade-1 dengue hemorrhagic fever the activated vascular endothelium evident by plasma leakage triggers the activation of coagulation creating a hypercoagulable and fibrinolysis state with enhanced fibrin-lysis still persist in the convalescence phase.