RỐI LOẠN ĐÔNG MÁU Ở TRẺ SỐC SỐT XUẤT HUYẾT DENGUE

Abstract

Objectives: To investigate the coagulation disorder in children with dengue hemorrhagic fever shock at Children's Hospital 1. Subjects and methods: Studied on 466 children diagnosed with dengue hemorrhagic fever shock admitted to Children's Hospital 1 from December 2017 to June 2019. Coagulation was performed at the time of shock (T0), 24 h (T24) and 48h (T48) after the time of shock. Results: The mean age was 9.4 ± 3.1 years old, of which 251 (53.9%) were boys. 4.7% had clinical manifestations of bleeding, of which 7 cases of gastrointestinal bleeding (1.5%), 7 cases of nosebleeds (1.5%), 2 cases of bleeding gums (0. 4%), menstruation lasted 6 cases (1.3%). During the treatment of gastrointestinal bleeding, there were 5 more cases, of which the total number of severe gastrointestinal bleeding requiring blood transfusion was 6 cases (1.3%). The average value of platelet count (unit x10³/mm³) at the time of T0, 24, 48 was 38.9 ± 24.1, 27.3 ± 24.1; 36 ± 27 respectively. The rate of thrombocytopenia at time T0, 24, 48 respectively: 84.3%; 97.8% and 100%. The rate of APTT prolonging at time T0, 24, 48 was 25.4%, respectively; 78.3% and 66.7%. The rate of prolongation of PT at time T0, 24, 48 was 4.4%, respectively; 39.1% and 44%. The rate of reduction of fibrinogen < 1 g/l at T0, 24, and 48, respectively, was 3%, 54.9% and 32%. At the time of admission, there were 70 coagulation disorders (25.9%), of which 6 cases (2.2%) met DIC criteria. During 48 hours of follow-up for coagulopathy 140 (40.8%) and DIC were 39 cases (11.4%). The percentage of children requiring transfusion of erythrocytes, platelets, fresh frozen plasma, and cold precipitate, respectively, was 3.2%; 3.6%; 2.4% and 3.2%. Conclusion: Coagulation disorder had the rate of 40.8% in dengue hemorrhagic fever shock in children, in which DIC was 11.4%. Severe clinical manifestations have a low rate. The number of children requiring transfusion of blood and blood products was low