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Suffering from dengue. Treatment and test done. Suggest what should I do?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
Hi, My son is suffering from dengue positive once and after fifteen days it becomes negative, than itp with low platelate. During the treatment bone expression shows no evidence, US showed normal spleen, PBS shows severe isolated thrombocytopenia. Platelate count when done on electronic equipment (CBC)shows lesser count ( upto 0000) but while doing manually it shows count range from 1.0 lac to 1.5 lac. Other parameters except platelet are normal. Dr has said that size of platelete has increased due to which machine could not judged the right amount. CT Scan is normal, kidney test is normal. Dr advice and noted erythema nodosumlike lesionon the skin and his XXXXXXX showed anti-Jo 1 and anti-RO-52 Ab Positve they adiviced to take HCQS .
Follwing parameters in platelate were found
1) Toxic Granulation ( +).
2) Few reactive lymphocytes ( +).
3) Occasional giant platelet(+).

Kindly advice what to do, he is presently having platelet count around 0000.

Posted Thu, 9 Aug 2012 in Infections
Answered by Dr. Hema Yadav 3 hours later
Thanks for posting your query.
Prolonged thrombocytopenia in a usual case of dengue virus infection is uncommon. Dengue-related thrombocytopenia is self-limiting and responds within 3-5 days. An underlying immunological disorder may be responsible for delayed return of platelet count to a normal level.
Considering the details you have provided your child most probably seems to have a secondary immune thrombocytopenia Triggered by the viral infection( dengue ) and has an underlying autoimmune disorder.
The platelet count on coulter machine is not very reliable and in such cases manually counted smear reports are to be assumed as the definite platelet count.
The approach to treatment depends on many factors such as
1. First and foremost, symptoms of the patient ie If your child has any bleeding or symptomatic thrombocytopenia then he needs to be treated with Intravenous immunoglobulin or anti D or corticosteroids which will bring up his platelets & relieve his symptoms .
2. Treatment of the underlying cause will be treatment of septicemia and any other trigger as found clinically .
3. The anti nuclear antibodies suggest an underlying autoimmune disorder and if the above approaches fail to show a therapeutic response then a trial of treatment with the HCQs( hydroxychloroquine) would be advisable .

I assume you have consulted a team of doctors including an oncologist or hematologist or immunologist for the best interest of your child . Please do not panic as though such cases of prolonged immune thrombocytopenia are rare there are cases reported where patients have achieved remission and normal platelet count after weeks to months of appropriate therapy ( as mentioned above).
So don't lose hope and be positive.
Hope I have answered your query.
Wishing your child a speedy recovery.
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