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Fibrinogen Metabolism and Disseminated Intravascular Coagulation in Dengue Hemorrhagic Fever
In 29 patients with dengue hemorrhagic fever (DHF), 12 with grade 2 and 17 with grades 3 and 4, fibrinogen metabolism was studied by using 125I-fibrinogen; 11 of these patients were studied during shock. Hemostatic studies were also performed to search for evidence of disseminated intravascular coagulation (DIC). Increased intravascular coagulation, as judged by rapid T½ of 125I-fibrinogen, as well as evidence of DIC by hemostatic changes was found in 82% of the patients with DHF grades 3 and 4, whereas 58% of the patients with DHF grade 2 had rapid T½ and only 17% had DIC. Of the 11 patients studied during shock, 91% had both rapid T½ and evidence of DIC, whereas 63% of the 18 patients without shock had rapid T½ and only 11% of this latter group had DIC. A correlation between the increased fibrinogen consumption as judged by rapid T½ of 125I-fibrinogen, DIC, clinical severity, and shock was demonstrated. The role of DIC in the pathogenesis of DHF is discussed, and heparin is suggested for patients with prolonged shock and severe acidosis when DIC becomes clinically apparent.