A 28-year-old woman presents on day 5 of dengue fever with severe abdominal pain, persistent vomiting, and bleeding gums. Platelet count has dropped to 18,000/μL. Haematocrit is rising (from 38% to 44%). Blood pressure is 95/65 mmHg. What is the WHO dengue severity classification of this patient, and what is the immediate management?
- A Severe dengue (dengue shock syndrome); colloid fluid replacement and platelet transfusion immediately
- B Dengue with warning signs; IV isotonic crystalloid fluid resuscitation as per WHO protocol ✓
- C Dengue fever without warning signs; discharge with oral hydration
- D Dengue haemorrhagic fever grade IV; fresh frozen plasma for coagulopathy
Explanation
This patient has dengue with warning signs (WHO 2009 classification): abdominal pain, persistent vomiting, bleeding (gums), rising haematocrit (>20% rise indicating plasma leakage), and hypotension but not in frank shock. Management per WHO dengue management guidelines is IV isotonic fluid resuscitation (normal saline or Ringer's lactate) at 5–7 mL/kg/hour, with close monitoring of haematocrit and clinical response. Severe dengue (dengue shock syndrome proper) requires fluid boluses of 10–20 mL/kg. Platelet transfusion is reserved for platelet <10,000 or active significant bleeding — prophylactic transfusion for thrombocytopenia alone is NOT recommended. FFP is not part of routine management unless coagulopathy with bleeding.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.