Treatment of Dengue Fever with Severe Haemorrhage and Unexplained Hypotension
Severe dengue can escalate to critical haemorrhage requiring immediate targeted intervention. This protocol applies specifically to patients presenting with established or suspected severe bleeding, a fall in haematocrit, and unexplained hypotension — a distinct and high-risk subset of severe dengue.
Clinical scenario
Severe dengue with severe haemorrhage: established or suspected severe bleeding accompanied by a fall in haematocrit and unexplained hypotension. Blood transfusion is reserved for this specific presentation — it is not indicated for all dengue patients, only for those who meet these criteria.
Management approach — partial overview
The core intervention is blood replacement to address significant haemorrhage. In selected patients without organ failure, an additional haemostatic agent may be considered. The complete stepwise regimen, including response thresholds and second-step options, is available in the full protocol.
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 there is no improvement, then the patient may be required one or more aliquots.
- Recombinant Factor 7 might be helpful in some patients without organ failure, but it is very expensive and generally not available.
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