Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue

Abstract

Background: Dengue viral infections may occur as epidemics and are of public health concern in India especially due to high mortality in advanced stages. Early diagnosis and treatment reduces the mortality significantly. To assess the utility of atypical lymphocyte counts with relation to platelet counts as a marker for severe dengue.Methods: A total of 132 serologically proven (by rapid card method) cases of dengue with atypical lymphocytosis (≥10%) and thrombocytopenia (<150×109/l) were analyzed during November 2016. The complete blood counts (obtained from automated hematology analyzer and Leishman stained peripheral smears) were analyzed.Results: Dengue infections were mostly seen in younger age (12-25 years) with slight male predominance. The relevant haematology findings noted were leukopenia in 36% and severe thrombocytopenia (<50×109/l) in 57% of cases. The differential count showed lymphocytosis in 64% with significant (≥20%) atypical lymphocytes in 52% which inversely correlated with platelet counts. Atypical lymphocytosis (≥20%) was noted in 9% of cases with mild as against 32% of severe thrombocytopenia.Conclusions: Atypical lymphocyte count can be used as predictor of severe thrombocytopenia and severe dengue. This helps in early diagnosis and proper management and drastic reduction in mortality.