The role of platelet antibody and bone marrow in adult dengue hemorrhagic fever with thrombocytopenia

Adult dengue haemorrhagic fever (DHF) cases are increasing rapid\,, wlûle most of tlre studies reported children cases. Cotttroversies in DHF pathophysiology and trealntent are still amatter of debate. In this slutly, bone nnrrow punctta'e, platelet antibody url D-Dimer examinationwere carriedout in29 adilt DHFpatient (ntore than I6years).The diagnosis of DHF was confinrrcdclùical\, ttsing tlrc WHO criteria, rapid immunochromatographic exantinatiort sr.tpporled by henngglutination inhibition (HI) test to clarify the patlngenesis of thrombocytopenia and the pathophysiology of DHF ùt adult patiertt. Besides that, steroid was given in ùnmunosuppres.rit,e dose during 5 days to selected patients (on double blind basis). TIrc cross sectiortal study, cohort study and double blind trial were tlrc methods used in this study. The results showed that periferal processes apparently were ntore affected than bone manow suppressiort in causing throntbocytopenia, in the less thatr 5 day fever group, with platelet antibody as a leading factor (P = 0.01 I2). While, in the more than 5 day fever group, there are no sigttiJicant variable. If steroid was given, in the less than 5 day fever group, apparently the length ofthrombocytopenia could be decreased (P < 0.05), while the throtnbocyte level could be kept front lowering too fast, in the ntore tlnn 5 dayfever group (P < 0.1). Conclusion: Most of thrombocytopeniawas caused by perifural process than bone marrow suppression. In tlrc l.ess than five day fever group, the steroid could decrease the length of llrontbocyloltenia and kzep the thrombocyte level fronr Iowering too fast. However, in the more than 5 day fever group it only kept tlrc tlrontbocyte level front lowering too fast. Keyw ords : re t iculo endothelial sys tent, steroid, inmwto lo gic reactiott * Deltartment of lrûernal Medicine, Faculty of Medicine , University o.f Indonesia/Ciltto Mangunkusumo Hospital ' Divisiott of Hematologlt-Medical Oncologt', Departmcnt of Irternal Metlicine, Futtlh' of Medicine Uttiversi1, o.f I ndorte s itt/ C i1tto M an g,rur ku s unt o H o slti tn L t' Diul.çirrrr oj Troltical antl lnfectiousDiseases, Depctrttnent of Intcmttl ]+'ledicine, Fotalû of Mcdicine University of , Itulottesict/ Cipto Mongunkusumo Hospital ! Depttrtnrcnt o.f Pediatrics, Faculty of Medicine (hiversitt of I nd one s ity'C ipto M a n g utkus nnro H ospital Dengue Hemorrhagic Fever (DHF) is still an endemic illness in Indonesia. Todav, DHF is endemic in 26 provinces (except Bengkulu;.1 In one of the surveys done by the Health Department of the Republic of Indonesia at nine cities, it was showcd thrtt Actles cr<'g1t1tti was prescl.lt in one third of the houses or public places investigutcd.' The lutcst data from thc Hcalth Department ol the Republic of Indonesia, Acdcs aegl'1tti was lbun

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