“CORRELATION OF THROMBOCYTOPENIA RECOVERY WITH SERUM VITAMIN B12 LEVELS IN DENGUE FEVER

Abstract

BACKGROUND:Dengue is one of the most rapidly emerging mosquito – borne viral disease which is now endemic to all the continents with a significant mortality in developing nations. Decrease in platelet count, problems of increased capillary permeability , bleeding manifestations and shock are the few factors which are the major contributor for poor disease outcome. Recovery from thrombocytopenia is seen to be variable in nature in different patients and as we know Vitamin B12 has a role in synthesis of blood cells. AIMS AND OBJECTIVE: This study is conducted to document correlation between vitamin B12 deficiency and severity of thrombocytopenia, platelet recovery and duration of hospital stay in dengue fever patients. MATERIALS AND METHODS:A prospective observational study was conducted in BLDE ( deemed to be university) Shri B.M Patil medical college Hospital and Research Centre, Vijayapura in patients diagnosed with Dengue Fever. Total blood cell count and serum Vitamin B12 levels were checked on day of admission and daily platelet counts were measured. Patients were divided into three groups on the basis of serum Vitamin B12 levels, Group A (B12 <150 pg/ml) , Group B(B12 < 151 – 300 pg/ml) and Group C (B12 >300 pg/ml). The duration of hospital stay until thrombocytopenia recovery/ Discharge/ Death was observed in all the groups along with daily platelet count. RESULTS: A total 65 patients were selected initially with Dengue Fever , out of which 4 were excluded as per exclusion criteria and total 61 patients were studied. Most common age group Page | 13 affected was of < 20 years of age with 42.6 % of patients, with a slight male preponderance as 52.5 % of patients were male. Out of total 67.2 % patients were found to be NS1 antigen positive, 24.6% of patients were IgM positive and 8.2% of patients were IgG positive. 18% of patients were in group A with serum Vitamin B12 < 150 pg/ml , 21.3 % of patients in group B with B12 151 – 300 pg/ml and 60.7 % of patients in group C with B12 levels of >300 pg/ml. Platelet recovery was observed to be slowest in group A with mean 6.455 days, 6.385 in group B and 4.703 in group C and p value of 0.011 (statistically significant ). Duration of hospital stay was observed to be longest in group A with mean 7.45 days, with 6.85 in group B and 4.81 in group C with a statistically significant p value of 0.001. 45.5% of patients of group A, 30.8% patients of group B and 19% patients of group C went for severe thrombocytopenia (platelet count <20,000 cumm). CONCLUSION :Vitamin B12 deficiency is a contributing factor for the development of severe thrombocytopenia in Dengue Fever patients. Its deficiency delays the recovery of thrombocytopenia in Dengue leading to prolonged Hospital stay creating an extra burden on patient as well as health infrastructure