Dengue with thrombocytopenia is a serious manifestation of dengue fever characterized by a significant drop in platelet count. Dengue, a mosquito-borne viral infection, can lead to complications when it causes a decline in platelets, essential for blood clotting. Thrombocytopenia increases the risk of bleeding and necessitates careful monitoring and medical intervention. Early diagnosis, supportive care, and appropriate medical management are crucial in addressing dengue with thrombocytopenia to prevent complications and promote a favorable patient outcome. Public health measures to control mosquito populations also play a key role in preventing the spread of dengue.

1. Mohd Abutaha Ansari
Pharm.D. (Intern)

2. 2
• Dengue, a prevalent mosquito-borne viral infection.
• This disease, transmitted by the Aedes mosquito, is
characterized by high fever, severe joint and muscle pain,
and in some cases, life-threatening complications.
• Dengue viruses are spread to people through the bite of an
infected Aedes species (Ae. aegypti or Ae. albopictus)
mosquito. These mosquitoes also spread Zika, chikungunya,
and other viruses.
Reference: who. int

3. 3
The Aedes mosquitoes have 4 stages :
• Egg
• Larva
• Pupa
• Adult
Reference: cdc.gov

4. 4
If symptoms occur, they usually begin 4–10
days after infection and last for 2–7 days.
Symptoms may include:
•High fever (40°C/104°F)
•Severe headache
•Pain behind the eyes
•Muscle and joint pains
•Nausea
•Vomiting
•Swollen glands
•Rash.
Severe dengue symptoms often come after
the fever has gone away:
•Severe abdominal pain
•Persistent vomiting
•Rapid breathing
•Bleeding gums or nose
•Fatigue
•Restlessness
•Blood in vomit or stool
•Being very thirsty
•Pale and cold skin
•Feeling weak.
Reference: who. int

5. 5
Reference: cdc.gov

6. 6
Reference: cdc.gov

7. 7
• Most cases of dengue fever can be treated at home with pain medicine.
Preventing mosquito bites is the best way to avoid getting dengue.
• Acetaminophen (paracetamol) is often used to control pain. Non-steroidal
anti-inflammatory drugs like ibuprofen and aspirin are avoided as they can
increase the risk of bleeding.
• CYD-TDV, brand name “Dengvaxia”, is currently the only marketed dengue
vaccine. The WHO has approved Dengvaxia for the age group 9–45 y, living
in a dengue-endemic region and having had laboratory-confirmed DENV
infection in the past.
• Dengvaxia has been reported to increase the risk of severe dengue in those
who experience their first natural dengue infection after vaccination
(seronegative individuals), due to the phenomenon of antibody-dependent
enhancement (ADE).
• Hence, prevaccination screening for past dengue infection is recommended.
Dengvaxia is currently not licensed in India.
Reference: Tayal A et al., 2023

8. 8
SUBJECTIVE
• Fever with chills
• Vomiting
• Dizziness x1day
• Body ache
• Black stools
• Itching all over body

9. 9
OBJECTIVE
Physical examination: Conscious /Drowsy/ Comatose
General examination: P: I : C: C : L: E
S.NO BLOOD PRESSURE PULSE RATE
1. 98/72 86
2. 100/70 90
3. 100/72 90
4. 102/78 92
5. 110/70 90
6. 110/70 92

10. 10
SOAP
S.NO. PLATELET
COUNT
LIVER FUNCTION
TEST
DENGUE
SEROLOGY
1. 0.80 Lac/cumm AST- 250 unit/L NS1 +ve
2. 0.95 Lac/cumm ALT – 107 unit/L
3. ALP – 154 unit/L

11. 11
ASSESSMENT
Based on subjective and objective evidence the
patient is suffering from Dengue NS1 +ve with
thrombocytopenia.

12. 12
PLANNING
•No treatment: No specific antiviral agents exist for dengue.
•Supportive care is advised: Patients should be advised to stay well
hydrated and to avoid aspirin (acetylsalicylic acid), aspirin-containing
drugs, and other nonsteroidal anti-inflammatory drugs (such as ibuprofen)
because of their anticoagulant properties.
•Fever should be controlled with acetaminophen and tepid sponge baths.
•Febrile patients should avoid mosquito bites to reduce the risk of further
transmission.
Reference: cdc.gov

14. 14
• Category: Antibiotic
• M.O.A: Ceftriaxone is a bactericidal agent that
acts by inhibiting bacterial cell wall synthesis.
Ceftriaxone has activity in the presence of some
beta-lactamases, both penicillinases and
cephalosporinases, of gram-negative and gram-
positive bacteria.
• Dose: 1 gm I.V
• Side effects: Pain and redness at the injection site,
Warmth, tightness, and hardening of skin
following intravenous use, Diarrhea, ranging from
mild to severe, and Rash
• Justification: Treat bacterial infections in the body.
Reference: Micromedex.com

15. 15
• Category: Proton pump inhibitor
• M.O.A: Pantoprazole sodium is a proton pump
inhibitor (PPI) that covalently binds to the (H(+),
K(+))-ATPase enzyme system at the secretory
surface of the gastric parietal cell. This action
suppresses the final step in gastric acid production
and leads to the inhibition of both basal and
stimulated acid secretion
• Dose: 40 mg I.V
• Side effects: Diarrhea, flatulence, dizziness,
headache, vomiting, and stomach pain.
• Justification: reduce the amount of acid produced
in the stomach.
Reference: Micromedex.com

16. 16
• Category: Anti-emetic
• M.O.A: Ondansetron is a selective 5-
hydroxytryptamine-3 (5-HT3)-receptor
antagonist used for the prevention of
chemotherapy-induced nausea and
vomiting. Ondansetron may work by
blocking 5-HT3 receptors peripherally on
vagal nerve terminals and centrally in the
chemoreceptor trigger zone.
• Dose: 4 mg I.V
• Side effects: headache, diarrhea,
constipation, dizziness, and drowsiness.
• Justification: Used to prevent nausea and
vomiting.
Reference: Micromedex.com

17. 17
• Category: Analgesics
• M.O.A: work by reducing the production
of prostaglandins in the brain that cause
pain and fever. This makes it effective for
alleviating pain and reducing fever.
• Dose: 650 mg P/O
• Side effects: Rash, itching/swelling
(especially of the face/tongue/throat),
severe dizziness, trouble breathing.
• Justification: Relieved from pain and
fever.
Reference: Micromedex.com

18. 18
• Category: Ursodeoxycholic acid
• M.O.A: works by reducing the production and
absorption of cholesterol in the liver, which in turn
decreases the formation of cholesterol-based
gallstones. It also helps to increase the secretion of
naturally occurring bile in the gallbladder, which
can lead to the dissolution of small cholesterol
gallstones.
• Dose: 150 mg P/O
• Side effects: Diarrhea, upset stomach, nausea,
abdominal pain, constipation, and headache
• Justification: Works by reducing the amount of
cholesterol in the blood.
Reference: Micromedex.com

19. 19
• Category: leukotriene modifiers.
• M.O.A: Montelukast blocks inflammatory
leukotrienes, reducing airway constriction
and inflammation. Levocetirizine is an
antihistamine that blocks the effects of
histamine, relieving allergy symptoms.
Together, they provide a dual-action
approach to manage allergic conditions
and asthma.
• Dose: 15 mg P/O
• Side effects: Headache, nausea, dry
mouth, dizziness.
• Justification: Treat allergic skin conditions
with inflammation and itching.
Reference: Micromedex.com

20. 20
• Category: Second-generation anti-histamines
• M.O.A: Bilastine works by blocking the H1 histamine
receptors in the body, preventing histamine from binding
to these receptors. Histamine is responsible for allergy
symptoms. By blocking these receptors, bilastine
reduces the effects of histamine, leading to relief from
symptoms like sneezing, runny nose, itchy or watery
eyes, and itching of the skin. Bilastine's non-sedating
nature makes it a popular choice for allergy relief
without causing drowsiness.
• Dose: 12 mg P/O
• Side effects: Headache, dizziness, dry mouth, upset
stomach, fatigue
• Justification: Reduces the development of allergic
symptoms due to the release of histamine from mast
cells.
Reference: Micromedex.com

21. 21
• Category: Cephalosporin antibiotic.
• M.O.A: Cefixime, a semisynthetic
cephalosporin, is a broad-spectrum
bactericidal agent that inhibits cell wall
synthesis and is stable in the presence of
certain beta-lactamases.
• Dose: 200 mg P/O
• Side effects: Diarrhea, upset stomach,
nausea, abdominal pain, constipation, and
headache
• Justification: Cefixime is a cephalosporin
antibiotic that works by killing bacteria.
Reference: Micromedex.com

22. 22
• Category: Proton pump inhibitor
• M.O.A: Pantoprazole sodium is a proton pump
inhibitor (PPI) that covalently binds to the (H(+),
K(+))-ATPase enzyme system at the secretory
surface of the gastric parietal cell. This action
suppresses the final step in gastric acid production
and leads to the inhibition of both basal and
stimulated acid secretion
• Dose: 40 mg P/O
• Side effects: Diarrhea, flatulence, dizziness,
headache, vomiting, and stomach pain.
• Justification: reduce the amount of acid produced
in the stomach.
Reference: Micromedex.com

23. 23
MEDICINES DOSE ROUTE FREQUENCY DURATION
TAB. ZIFI 200 mg P/O BD 7 days
TAB. PAN 40 mg P/O OD/BBF 7 days
TAB. DOLO 650 mg P/O SOS 7 days
TAB. UDILIV 150 mg P/O BD 7 days
ORS+ plenty of oral fluids

24. 24
A clinical pharmacist counseling a patient with dengue
and thrombocytopenia would typically cover the following
points:
• Fluid Intake: Encourage increased fluid intake,
especially oral rehydration solutions, to prevent
dehydration.
• Pain Management: Discuss pain relief options that are
safe for dengue, such as acetaminophen, and advise
against non-steroidal anti-inflammatory drugs
(NSAIDs) due to the risk of bleeding.
• Rest: Stress the importance of rest to help the body
recover.
• Monitoring: Instruct the patient to monitor for warning
signs like persistent vomiting, severe abdominal pain,
or bleeding, and seek medical attention if these occur.
• Bleeding Precautions: Advise gentle oral care and
use of soft toothbrushes to prevent bleeding from the
gums and mouth.
• Follow-Up: Emphasize the need for regular follow-up

25. 25
• Dengue and severe dengue (who.int)
• Tayal A, Kabra SK, Lodha R. Management of dengue: an updated review. Indian Journal of
Pediatrics. 2023 Feb;90(2):168-77.
• Treatment | Dengue | CDC
• Disease Result Page - Quick Answers - Definition (micromedexsolutions.com)

26. 26