A 25-year-old man presents on day 5 of dengue fever with abdominal pain, vomiting, and restlessness. Platelet count drops to 42,000/µL. Haematocrit rises from 36% to 44% (> 20% increase). BP is 95/70 mmHg. What dengue phase/category is this and what is the management?
- A Dengue with warning signs (plasma leakage, haematocrit rise > 20%) — Group B; admit for IV crystalloid fluid therapy with close monitoring ✓
- B Dengue without warning signs — oral hydration and outpatient monitoring
- C Severe dengue with shock (DSS) — immediate platelet transfusion to > 50,000
- D Dengue haemorrhagic fever Grade III — whole blood transfusion is first-line
Explanation
This patient has dengue with warning signs (WHO 2009 classification, Group B): abdominal pain, vomiting, clinical restlessness, haematocrit rise > 20% (36 → 44%, indicating plasma leakage/pre-shock state), and thrombocytopenia < 100,000. This mandates hospital admission for IV fluid therapy (crystalloids: Ringer's lactate or isotonic saline at 5-7 mL/kg/hour with stepwise reduction) and close monitoring. Platelet transfusion is not routinely indicated unless there is spontaneous bleeding with critically low platelets (< 20,000). Haematocrit rise, not just platelet count, is the key monitoring parameter reflecting plasma leakage.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.