Background: Severe thrombocytopenia is a common manifestation in adult dengue. It could be associated with higher risk of life-threatening bleeding. Prophylactic platelet transfusion to prevent bleeding is a traditional practice, but It still has remained strongly questionable. Blood component transfusion has been known as potential risk for the patients. It can complicate with pulmonary injury or infection. Both fibrinogen and platelets are the main determinants of clot firmness, and fibrinogen has been considered a potential hemostatic factor that can compensate thrombocytopenia.

Aims: We reported a succesfull case of an adult dengue patient admitted in the intensive care unit with severe thrombocytopenia, treated with fibrinogen concentrate replacement instead of prophylactic platelet transfusion, guided by thromboelastometry.

Methods: This is a case report.

Results: A 28-year-old, white, male, with a history of liver transplantation due to primary cholangitis was admitted in the ICU with the diagnosis of dengue and severe thrombocytopenia. His physical examination revealed a GCS 15, HR: 80 bpm,BP:120/80 mm/Hg, spontaneous breathing, normal abdominal examination, preserved diuresis, disseminated rash throughout the body. Lab tests at the admission showed Hb 11.5 g/dl, Ht 35.2%, leucocytes 900 m/l, platelets 16.000/mm³_, fibrinogen 174 mg/dl, INR 1.1, creatinine 0.92 mg/dl, urea 31 mg/dl, ALT 917 u/l, ASP 699 u/l, bilirubin 0.3 mg/dl, CRP 3.13 mg/dl. NS 1 was positive for dengue. Thromboelastometry identified hypocoagulable state due to lower platelet count and fibrinogen concentration (Figure 1 and 2). 8 grams of fibrinogen concentrate was replaced to increase the clot firmness , instead of platelet concentrate transfusion, to avoid spontaneous bleeding. This patient was discharged from the ICU with an improvement in his leucopenia, thrombocytopenia and liver function only with fibrinogen concentrate replacement. No bleeding no further transfusion.

Conclusions: In this case, fibrinogen replacement guided by thromboelastometry prevented spontaneous bleeding due to dengue related-severe thrombocytopenia, with no need of platelet transfusion.

[Figure 1: Relationship between MCF in EXTEM and FIBTEM]

[Figure 2: Relationship between CFT and platelets]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/fibrinogen-concentrate-replacement-guided-by-thromboelastometry-can-improve-clot-strenght-in-adult-dengue-with-severe-thrombocytopenia/