The role of platelet antibody and bone marrow in adult dengue hemorrhagic fever with thrombocytopenia

Adult dengue haemorrhagic fever (DHF) cases are increasing rapidly, while most of the studies reported children cases. Controversies in DHF pathophysiology and treatment are still a matter of debate. In this study, bone marrow puncture, platelet antibody and D-Dimer examination were carried out in 29 adult DHF patient (more than 16 years). The diagnosis of DHF was confirmed clinically using the WHO criteria, rapid immunochromatographic examination supported by hemagglutination inhibition (HI) test to clarify the pathogenesis of thrombocytopenia and the pathophysiology of DHF in adult patient. Besides that, steroid was given in immunosuppressive dose during 5 days to selected patients (on double blind basis). The cross sectional study, cohort study and double blind trial were the methods used in this study. The results showed that periferalprocesses apparently were more affected than bone marrow suppression in causing thrombocytopenia, in the less than 5 day fever group, with platelet antibody as a leading factor (P = 0.0112). While, in the more than 5 day fever group, there are no significant variable. If steroid was given, in the less than 5 day fever group, apparently the length of thrombocytopenia could be decreased (P < 0.05), while the thrombocyte level could be kept from lowering too fast, in the more than 5 day fever group (P < 0.1). Conclusion: Most of thrombocytopenia was caused by periferal process than bone marrow suppression. In the less than five day fever group, the steroid could decrease the length of thrombocytopenia and keep the thrombocyte level from lowering too fast. However, in the more than 5 day fever group it only kept the thrombocyte level from lowering too fast.