Management of Dengue Hemorrhagic Fever

Diagnosis and Classification

The Centers for Disease Control and Prevention (CDC) criteria for Dengue Hemorrhagic Fever (DHF) include acute febrile illness with minor/major bleeding phenomena, thrombocytopenia ≤100,000/mm³, and evidence of plasma leakage documented by hemoconcentration, which is met in this patient 1, 2
The World Health Organization (WHO) recommends reserving platelet transfusion for active significant bleeding or high risk of life-threatening bleeding, applicable to this patient with severe thrombocytopenia and active bleeding 3

The American College of Critical Care Medicine recommends aggressive intravenous fluid therapy as the cornerstone of management for dengue hemorrhagic fever, directly reducing mortality 5
Clinical endpoints of adequate resuscitation include warm extremities, capillary refill <3 seconds, urine output ≥0.5 mL/kg/hour, and return to baseline mental status 5

The CDC recommends monitoring for dengue shock syndrome, which includes hypotension for age and narrow pulse pressure ≤20 mmHg, in patients with DHF 1, 2
The WHO recommends monitoring vital signs, hematocrit, urine output, mental status, and peripheral perfusion every 2-4 hours in patients with severe dengue 1, 2, 5
If shock develops despite fluid resuscitation, consider vasopressors (dopamine or epinephrine) 5

Elevated hematocrit and hemoglobin levels indicate hemoconcentration from plasma leakage, while mild transaminitis and hyponatremia are common in dengue 1, 2
The CDC recommends monitoring for acute kidney injury in patients with dengue, as indicated by elevated creatinine levels 1, 2

The WHO recommends platelet transfusion for active significant bleeding or high risk of life-threatening bleeding in patients with severe thrombocytopenia, as seen in this patient 3
A platelet count of >50,000/mm³ is typically required for invasive procedures, with a higher threshold of >100,000/mm³ considered for neuraxial procedures due to the risk of spinal hematoma 4

Tranexamic acid is an antifibrinolytic agent that may be used to manage bleeding in dengue patients, while NSAIDs and aspirin should be avoided due to their increased bleeding risk 3, 7, 8
Paracetamol may be used for fever management in dengue patients 7, 8

The critical phase of dengue typically lasts 24-48 hours, followed by spontaneous recovery, with platelet count and hematocrit normalizing as plasma leakage resolves 1, 2
Close monitoring should continue until platelet count >50,000/mm³ and hematocrit is stable 3