Treatment of Dengue Fever with Severe Bleeding
This protocol addresses severe dengue complicated by severe haemorrhage — covering patients with established severe bleeding, or those with suspected severe bleeding indicated by a falling haematocrit alongside unexplained hypotension.
Clinical Situation
In severe dengue, significant haemorrhage can arise from multiple sites. The combination of a fall in haematocrit and unexplained hypotension signals potential major blood loss requiring prompt assessment. Blood transfusion is indicated only in patients who meet the threshold for established or suspected severe bleeding on these criteria.
Management Approach
The priority is to identify and stop the source of bleeding — the interventions required differ by anatomical site. Blood replacement is an integral part of management when haemorrhage is significant. For certain presentations, adjunctive medical therapy may also have a role.
The complete evidence-based regimen — including site-specific bleeding-control measures, replacement guidance, and adjunctive therapy — is available in the full structured protocol below.
References
- Severe haemorrhage
- Blood transfusion should be given only to patients with established severe bleeding, or suspected severe bleeding (fall in HCT) with unexplained hypotension.
- If the source of bleeding is identified, attempts should be made to stop the bleeding.
- Severe epistaxis, for example, may be controlled by nasal packing.
- Endoscopy may be required to identify internal gastrointestinal bleeding.
- However, if this cannot be quantified, aliquots of 10 mL/kg of fresh whole blood or 5 mL/kg of freshly packed red cells should be transfused.
- In gastrointestinal bleeding, H-2 antagonists and proton pump inhibitors have been used, but there has been no proper study to show its efficacy.
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