scholarly journals A HOSPITAL-BASED RETROSPECTIVE COMPARATIVE STUDY OF COMPLICATIONS, OUTCOMES, CLINICAL AND LABORATORY PARAMETERS OF MALARIA WITH AND WITHOUT NEUROLOGICAL INVOLVEMENT

2016 ◽  
Vol 9 (1) ◽  
pp. e2017006 ◽  
Author(s):  
Sohaib Ahmad ◽  
Nadia Shirazi ◽  
Nowneet Kumar Bhat ◽  
Minakshi Dhar ◽  
Garima Mittal ◽  
...  
Keyword(s):  
Cerebral Malaria ◽  
Severe Malaria ◽  
Ventilatory Support ◽  
Neurological Complications ◽  
Adverse Outcomes ◽  
Neurological Involvement ◽  
Severe Thrombocytopenia ◽  
Laboratory Parameters ◽  
Retrospective Comparative Study ◽  
Demographic Attributes

Background & Objectives: Classically associated with Plasmodium falciparum, neurological complications in severe malaria is associated with increased morbidity and mortality. However, reports implicate the long considered benign Plasmodium vivax for causing severe malaria as well. We aimed to analyze the cerebral complications in malaria, and study if there is a specie-related difference in the presentation and outcomes.Methods: We retrospectively compared patients of malaria hospitalised from 2009-15, with (n=105) and without (n=1155) neurological involvement in terms of outcomes, complications, demographic attributes, clinical features, and laboratory parameters. Subsequently, the same parameters were studied in those with cerebral malaria due to mono-infections of vivax or falciparum and their co-infection.Results: Cerebral malaria was observed in 8.3% (58/696), 7.4% (38/513) and 17.6% (6/51) of vivax, falciparum and combined plasmodial infections respectively. Those with cerebral malaria had significantly (p<0.05) longer hospitalization, delayed defervescence, required mechanical ventilatory support and dialysis despite comparable levels of azotemia and renal insufficiency, and adverse outcomes compared to non-cerebral malaria. Severe thrombocytopenia, respiratory distress and mechanical ventilation were significantly (p<0.05) associated with P. vivax cerebral malaria.Conclusions:The plasmodial species were comparable in clinical and laboratory parameters and outcomes in cerebral malaria in isolation and in combination (p>0.05). P. vivax emerged as the predominant cause of cerebral malaria and its virulence was comparable to P. falciparum.

A Study on Relationship of Thrombocytopenia and Likelihood of Severe Malaria in Patients Admitted With Malaria in a Tertiary Care Hospital of Dakshina Kannada

2019 ◽  
pp. 1-7
Author(s):  
Mukhtarahmed Bendigeri ◽  
Apoorva Panchakshare ◽  
Nazir Attar ◽  
Prakruthi Jaladhar
Keyword(s):  
Renal Failure ◽  
Cerebral Malaria ◽  
Severe Malaria ◽  
Hepatic Dysfunction ◽  
Severe Disease ◽  
Tertiary Care ◽  
Plasmodium Species ◽  
Malarial Parasite ◽  
Severe Thrombocytopenia ◽  
Care Hospital

Background: Malaria continues to be a huge socioeconomic burden despite various measures taken to curb the spread worldwide. It is also a global concern and more so in countries with a resource-limited setting. This inspired us to look at variables that could represent a severe disease in those limited settings, one such parameter being thrombocytopenia in malaria.   Aims and Objectives: To find the relationship between thrombocytopenia and renal failure, hepatic dysfunction and cerebral malaria (severe malaria) and to identify if thrombocytopenia on the first day of admission increases the likelihood of severe malaria. Methods: The study included 85 patients admitted in Yenepoya medical college hospital with fever and peripheral smear or malarial parasite fluorescent test (MPFT) positive for Plasmodium species. Results: A total of 85 patients were included in the study. It was noted that the patients with profound thrombocytopenia (<20,000/ml) on day 1 were more commonly associated with manifestations of severe malaria-like cerebral malaria, renal failure, and jaundice. Platelet count of <50,000/ml was associated with increased incidence of  renal failure, hepatic dysfunction, and cerebral malaria and increased mortality by an odds ratio of 4.37 on multivariate analysis. Conclusions: It was noted in our study that the presence of thrombocytopenia in a case of acute febrile illness increases the probability of malaria. This finding along with clinical suspicion of malaria should entail early treatment initiation. We have also noted that the presence of profound and severe thrombocytopenia was found to have a statistically significant correlation with cerebral malaria, renal failure and jaundice, and increased mortality.

scholarly journals Elevated Plasma Phenylalanine in Severe Malaria and Implications for Pathophysiology of Neurological Complications

2006 ◽  
Vol 74 (6) ◽  
pp. 3355-3359 ◽  
Author(s):  
Bert K. Lopansri ◽  
Nicholas M. Anstey ◽  
Gregory J. Stoddard ◽  
Esther D. Mwaikambo ◽  
Craig S. Boutlis ◽  
...  
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Confidence Interval ◽  
Cerebral Malaria ◽  
Severe Malaria ◽  
Phenylalanine Hydroxylase ◽  
Neurological Complications ◽  
Healthy Children ◽  
Plasma Amino Acids ◽  
Plasma Phenylalanine

ABSTRACT Cerebral malaria is associated with decreased production of nitric oxide and decreased levels of its precursor, l-arginine. Abnormal amino acid metabolism may thus be an important factor in malaria pathogenesis. We sought to determine if other amino acid abnormalities are associated with disease severity in falciparum malaria. Subjects were enrolled in Dar es Salaam, Tanzania (children) (n = 126), and Papua, Indonesia (adults) (n = 156), in two separate studies. Plasma samples were collected from subjects with WHO-defined cerebral malaria (children), all forms of severe malaria (adults), and uncomplicated malaria (children and adults). Healthy children and adults without fever or illness served as controls. Plasma amino acids were measured using reverse-phase high-performance liquid chromatography with fluorescence detection. Several plasma amino acids were significantly lower in the clinical malaria groups than in healthy controls. Despite the differences, phenylalanine was the only amino acid with mean levels outside the normal range (40 to 84 μM) and was markedly elevated in children with cerebral malaria (median [95% confidence interval], 163 [134 to 193] μM; P < 0.0001) and adults with all forms of severe malaria (median [95% confidence interval], 129 [111 to 155] μM; P < 0.0001). In adults who survived severe malaria, phenylalanine levels returned to normal, with clinical improvement (P = 0.0002). Maintenance of plasma phenylalanine homeostasis is disrupted in severe malaria, leading to significant hyperphenylalaninemia. This is likely a result of an acquired abnormality in the function of the liver enzyme phenylalanine hydroxylase. Determination of the mechanism of this abnormality may contribute to the understanding of neurological complications in malaria.

scholarly journals Response of Severe EV71-Infected Patients to Hyperimmune Plasma Treatment: A Pilot Study

Pathogens ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 625
Author(s):  
Chonnamet Techasaensiri ◽  
Artit Wongsa ◽  
Thanyawee Puthanakit ◽  
Kulkanya Chokephaibulkit ◽  
Tawee Chotpitayasunondh ◽  
...  
Keyword(s):  
Therapeutic Potential ◽  
Antibody Therapy ◽  
Foot And Mouth Disease ◽  
Neurological Complications ◽  
Neurological Involvement ◽  
Healthy Donors ◽  
Enterovirus A71 ◽  
Number Of Patients ◽  
Causative Agents ◽  
East And Southeast Asia

Hand, foot, and mouth disease (HFMD) is highly prevalent in East and Southeast Asia. It particularly affects children under five years of age. The most common causative agents are coxsackieviruses A6 and A16, and enterovirus A71 (EV71). The clinical presentation is usually mild and self-limited, but, in some cases, severe and fatal complications develop. To date, no specific therapy or worldwide vaccine is available. In general, viral infection invokes both antibody and cell-mediated immune responses. Passive immunity transfer can ameliorate the severe symptoms of diseases such as COVID-19, influenza, MERS, and SARS. Hyperimmune plasma (HIP) from healthy donors with high anti-EV71 neutralizing titer were used to transfuse confirmed EV71-infected children with neurological involvement (n = 6). It resulted in recovery within three days, with no neurological sequelae apparent upon examination 14 days later. Following HIP treatment, plasma chemokines were decreased, whereas anti-inflammatory and pro-inflammatory cytokines gradually increased. Interestingly, IL-6 and G-CSF levels in cerebrospinal fluid declined sharply within three days. These findings indicate that HIP has therapeutic potential for HFMD with neurological complications. However, given the small number of patients who have been treated, a larger cohort study should be undertaken. Successful outcomes would stimulate the development of anti-EV71 monoclonal antibody therapy.

scholarly journals Parenteral artemisinins are associated with reduced mortality and neurologic deficits and improved long-term behavioral outcomes in children with severe malaria

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrea L. Conroy ◽  
Robert O. Opoka ◽  
Paul Bangirana ◽  
Ruth Namazzi ◽  
Allen E. Okullo ◽  
...  
Keyword(s):  
Executive Function ◽  
Hospital Mortality ◽  
Cerebral Malaria ◽  
Severe Malaria ◽  
Behavioral Outcomes ◽  
Artemisinin Derivatives ◽  
Neurologic Deficits ◽  
Adjusted Scores

Abstract Background In 2011, the World Health Organization recommended injectable artesunate as the first-line therapy for severe malaria (SM) due to its superiority in reducing mortality compared to quinine. There are limited data on long-term clinical and neurobehavioral outcomes after artemisinin use for treatment of SM. Methods From 2008 to 2013, 502 Ugandan children with two common forms of SM, cerebral malaria and severe malarial anemia, were enrolled in a prospective observational study assessing long-term neurobehavioral and cognitive outcomes following SM. Children were evaluated a week after hospital discharge, and 6, 12, and 24 months of follow-up, and returned to hospital for any illness. In this study, we evaluated the impact of artemisinin derivatives on survival, post-discharge hospital readmission or death, and neurocognitive and behavioral outcomes over 2 years of follow-up. Results 346 children received quinine and 156 received parenteral artemisinin therapy (artemether or artesunate). After adjustment for disease severity, artemisinin derivatives were associated with a 78% reduction in in-hospital mortality (adjusted odds ratio, 0.22; 95% CI, 0.07–0.67). Among cerebral malaria survivors, children treated with artemisinin derivatives also had reduced neurologic deficits at discharge (quinine, 41.7%; artemisinin derivatives, 23.7%, p=0.007). Over a 2-year follow-up, artemisinin derivatives as compared to quinine were associated with better adjusted scores (negative scores better) in internalizing behavior and executive function in children irrespective of the age at severe malaria episode. After adjusting for multiple comparisons, artemisinin derivatives were associated with better adjusted scores in behavior and executive function in children <6 years of age at severe malaria exposure following adjustment for child age, sex, socioeconomic status, enrichment in the home environment, and the incidence of hospitalizations over follow-up. Children receiving artesunate had the greatest reduction in mortality and benefit in behavioral outcomes and had reduced inflammation at 1-month follow-up compared to children treated with quinine. Conclusions Treatment of severe malaria with artemisinin derivatives, particularly artesunate, results in reduced in-hospital mortality and neurologic deficits in children of all ages, reduced inflammation following recovery, and better long-term behavioral outcomes. These findings suggest artesunate has long-term beneficial effects in children surviving severe malaria.

scholarly journals Liver dysfunction in COVID-19: a useful prognostic marker of severe disease?

2020 ◽  
pp. flgastro-2020-101689
Author(s):  
James Lok ◽  
Markus Gess
Keyword(s):  
Liver Function ◽  
Acute Phase ◽  
Liver Dysfunction ◽  
Acute Phase Proteins ◽  
Severe Disease ◽  
Ventilatory Support ◽  
Length Of Hospital Stay ◽  
Abnormal Liver Function ◽  
Adverse Outcomes ◽  
High Dependency

BackgroundCOVID-19 is a global pandemic caused by the novel coronavirus SARS-CoV-2. Risk factors and prognostic markers of severe disease remain to be fully determined, although some studies have suggested a correlation between abnormal liver function and adverse outcomes. Further studies are needed to investigate this further.MethodsThis retrospective study enrolled patients with a confirmed diagnosis of COVID-19 who were admitted to Kingston Hospital in the UK. Data collected included age, sex, ethnicity, comorbidity profile, biochemical markers of liver function and the acute phase response, and overall outcome.ResultsBetween 16 March 2020 and 30 April 2020, a total of 343 patients were admitted to the acute medical team at Kingston Hospital. Excluding those with a history of liver disease, 299 patients had liver function tests performed with abnormalities demonstrated in 44.8% of individuals. Derangement of liver function was associated with greater need for ventilatory support (p<0.001), admission to high dependency unit or intensive care (p<0.001) and increased length of hospital stay (p<0.001). Of note, liver dysfunction was more common in those of non-white ethnicity (p=0.007) and correlated with higher levels of C reactive protein (p=0.01) and ferritin (p<0.001).ConclusionAbnormal liver function is associated with a negative outcome among those hospitalised with COVID-19. The cause for this association is unclear, but correlation between abnormal liver function and higher serum levels of acute phase proteins suggest that dysregulation of the immune system in response to SARS-CoV-2 may be contributory.

Comparison of Severity of Symptoms and Outcome among Vaccinated and Non-Vaccinated Covid 19 Patients in Khyber Pakhtunkhwa, Pakistan

2021 ◽  
Vol 15 (7) ◽  
pp. 2334-2337
Author(s):  
Wali Gul ◽  
Kashif Ali Samin ◽  
Rashid Ahmad ◽  
Khalil Ullah ◽  
Gul Mehnaz ◽  
...  
Keyword(s):  
Economic Status ◽  
Adverse Outcomes ◽  
Medicine Department ◽  
Khyber Pakhtunkhwa ◽  
Icu Admission ◽  
Severity Of Disease ◽  
Group I ◽  
Group Ii ◽  
Severity Of The Disease ◽  
Retrospective Comparative Study

Objective: The aim of this study is to compare the severity of symptoms and outcomes among vaccinated and non-vaccinated COVID 19 patients in Khyber Pakhtunkhwa, Pakistan Study Design: A Retrospective/ Comparative study Place and Duration: The study was conducted at Medicine department of Lady Reading Hospital, Peshawar and DHQ Category A Hospital, Batkhela for duration of six months between December 2020 and May 2021. Methods: Total 170 patients of both genders had coronavirus disease were presented in this study. Patients were aged between 20-80 years. Demographical details of patients including age, sex, body mass index, residency and socio-economic status were recorded after taking informed written consent. Patients were admitted in COVID 19 ward. There were 70 vaccinated patients in group I and 100 non-vaccinated patients in group II. Co-morbidities among both groups were assessed. Effectiveness and outcomes among both groups were calculated in terms of mortality and reduction in severity of disease. Complete data was analyzed by SPSS 19.0 version. Results: There were 114 (67.1%) patients were males (50 in group I and 64 in group II) and 56 (32.4%) were females (28 in each group). Mean age of the vaccinated patients was 49.16 ±8.55 years with mean BMI 33.16 ±4.64 kg/m2 and in group II mean age was 47.18 ±4.77 years with mean BMI 31.12±12.73 kg/m2.Among 70 cases of group I, 40 (57.1%) were fully vaccinated and 30 (42.9%) patients received their first dose. 50 (71.4%) were educated in group I and in group II 46 (46%) patients were literate. Co-morbidities were diabetes mellitus, hypertension, ischaemic heart and chronic lung disease. Effectiveness among patients of group I was greater 55 (78.6%) as compared to non-vaccinated 36 (36%). Frequency of adverse outcomes hospitalization 10 (10%), ICU admission 14 (14%) and mortality 40 (40%) among non-vaccinated patients were significantly higher as compared to vaccinated patients in which hospitalization 3 (4.3%), ICU admission 2 (2.9%) and mortality was found in 10 (14.3%) cases. Conclusion: We concluded in this study that vaccination against coronavirus disease was effective and helpful for the reduction in severity of the disease. Except this the frequency of adverse outcomes (hospitalization, ICU admission and mortality) can be minimized by vaccination and there is need to give awareness among people to get vaccinated early. Keywords: COVID 19, Vaccination, Pandemic, Mortality

Nervous system

2013 ◽  
pp. 140-145
Author(s):  
Andrew Graham ◽  
Clare Galton
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Lupus Erythematosus ◽  
Transverse Myelitis ◽  
Neurological Complications ◽  
Neurological Involvement ◽  
Disease Modifying Therapy ◽  
Entrapment Neuropathies ◽  
System P ◽  
Tunnel Syndrome

Rheumatological conditions may be complicated by a variety of both central and peripheral nervous system disorders. Common complications such as entrapment neuropathies are familiar to rheumatologists but accurate diagnosis of less common neurological disorders may be challenging; careful clinical reasoning is essential, supplemented where necessary by imaging, neurophysiology, and other special investigations including cerebrospinal fluid examination. Complications vary according to the nature of the background condition. In rheumatoid arthritis, neurological involvement is typically related to the mechanical consequences of advancing disease; most commonly, entrapment neuropathies such as carpal tunnel syndrome and cervical myelopathy due to atlantoaxial subluxation. By contrast, neurological involvement in systemic lupus erythematosus (SLE) tends to occur earlier in the disease course, with a much wider range of manifestations. The management of stroke or seizures in SLE is not necessarily any different from that in the general population, unless complicated by the antiphospholipid syndrome. However, less common neurological syndromes may demand more specific investigation and treatment. For example, longitudinally extensive transverse myelitis and recurrent optic neuritis (neuromyelitis optica, or Devic’s disease) is frequently associated with antibodies to aquaporin-4, and is highly likely to relapse unless treated vigorously with humoral immunosuppression. Nervous system involvement in vasculitis is common. Finally, not all neurological disorder in rheumatological disease is necessarily due to the underlying condition; neurological complications of disease-modifying therapy are increasingly recognized, in particular central and peripheral nervous system demyelination associated with TNF-α‎‎ inhibitors.

scholarly journals Circulatory hepcidin is associated with the anti-inflammatory response but not with iron or anemic status in childhood malaria

Blood ◽  
2013 ◽  
Vol 121 (15) ◽  
pp. 3016-3022 ◽  
Author(s):  
Florence Burté ◽  
Biobele J. Brown ◽  
Adebola E. Orimadegun ◽  
Wasiu A. Ajetunmobi ◽  
Nathaniel K. Afolabi ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Cerebral Malaria ◽  
Severe Malaria ◽  
Severe Malarial Anemia ◽  
Key Points ◽  
Mild Malaria ◽  
Anti Inflammatory ◽  
Childhood Malaria ◽  
Malarial Anemia

Key Points Hepcidin rises more dramatically in mild malaria than in severe malaria. Hepcidin levels are linked to inflammation, not anemia, in severe malarial anemia and cerebral malaria.

scholarly journals Cerebrovascular Injury Following Scorpion Sting and Snake Envenomation: A Case Series

2018 ◽  
Vol 45 (6) ◽  
pp. 669-674 ◽  
Author(s):  
Ajay Mishra ◽  
Aditya Binu ◽  
George Abraham ◽  
Harshad Vanjare ◽  
Tina George ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Neurological Involvement ◽  
Scorpion Sting ◽  
Male Predominance ◽  
Cerebrovascular Injury ◽  
Snake Envenomation

AbstractBackgroundNeurological complications following snake and scorpion bite are diverse. Literature regarding patterns of cerebrovascular injury (CVI) and outcomes among these patients is scarce. This is a descriptive study of the clinical profile, brain imaging findings, mechanisms of injury, vascular territory involvement and outcomes of CVI following scorpion and snake envenomation, in a tertiary care center in South India.MethodologyPatients with scorpion sting- and snake envenomation-related complications were retrospectively enrolled. Neuroimaging was performed on five patients with each envenomation, and they were found to have neurological involvement. On imaging, three patients were found to have a CVI. Clinical, radiological parameters and outcomes of these patients were studied. We also performed a review of the literature and analyzed the finding of all the cases.ResultIn all, three patients each had evidence of CVI in imaging. An additional 32 reports of scorpion sting-related CVI and 35 reports of snake envenomation-related CVI were identified from the literature. There was a male predominance among these patients. Mean age of the patients with scorpion sting was 42.8 years as compared with 33 years for the patients with snake envenomation. Features of severe envenomation were present in all patients. Persistently depressed sensorium and new-onset focal neurological deficits were seen in 70% of all patients. Infarcts were seen in 88% of patients with snake envenomation and 53% of patients with a scorpion sting. Mortality was 28% among patients with a scorpion sting as compared with 8% with snake envenomation.ConclusionCerebrovascular injuries are uncommon neurological manifestations following scorpion and snake envenomation. These tend to occur in younger patients. Infarcts are more common than bleeds.

Control of Massive Bleeding in Dengue Hemorrhagic Fever with Severe Thrombocytopenia by Use of KhamRho IV Anti D®.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2086-2086
Author(s):  
Satya Prakash Yadav ◽  
Sunil Dutt Sharma ◽  
Gaurav Kharya ◽  
Dhiren Gupta ◽  
Anupam Sachdeva
Keyword(s):  
Platelet Count ◽  
General Condition ◽  
Ventilatory Support ◽  
Pulmonary Hemorrhage ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Massive Bleeding ◽  
Factor Vii ◽  
Severe Thrombocytopenia ◽  
Activated Factor Vii

Abstract Dengue hemorrhagic fever (DHF) is a potentially lethal complication of mosquito borne viral disease, Dengue Fever. Thrombocytopenia is a constant finding in DHF/Dengue Shock Syndrome (DSS). The cause of thrombocytopenia is not clearly understood and may be due to decreased platelet production, increased peripheral destruction, or both. IV Anti-D is currently licensed to treat immune thrombocytopenia purpura (ITP) in pediatric or adult patients. Unlike other disease states, which may produce ITP, the thrombocytopenia associated with DHF has an acute onset and a high mortality rate if untreated. Use of Intravenous anti D (IV anti-D) for such bleeding has not been documented in the literature which prompted these descriptions Method: We report 2 cases that fulfilled the WHO criteria of DHF: high fever, bleeding, positive tourniquet test, severe thrombocytopenia (&lt;10,000 /mm3) and hemoconcentration (Hematocrit increase&gt; 20%). Case 1: 14-year-old boy was admitted with DHF and hypotension. He was stabilized after a normal saline (NS) bolus and continued on intravenous fluids @3ml/kg/hr. On day 3 of admission he again became hypotensive that responded to NS bolus and increased fluid rate of 5 ml/kg/hr. On day 4 child developed respiratory distress had to be ventilated in view of associated hypotension and deteriorating general condition. Echocardiogram showed global hypokinesia with Left Ventricular Ejection Fraction of 43% so started on inotropes. Few hours later he developed massive pulmonary hemorrhage. The pulmonary hemorrhage continued despite giving 42 units of platelets, 10 units of FFP and 3 units of aphaeresis. Platelet count remained less than 10,000 / mm3 despite repeated platelet transfusions. Recombinant Activated factor VII was given at a dose of 90 ug/kg which corrected coagulation profile to normal but hemorrhage still persisted. KhamRho IV Anti D® 50ug/kg was administered after which child showed dramatic response and bleeding stopped after 4 hr and platelets increased to 30,000 after 6 hr. Over next 48 hrs platelet count rose further. He was gradually weaned off the inotropes and ventilatory support. Case 2: 5-year-old girl admitted with DHF. On admission she was hypotensive and was having massive gastrointestinal bleed. She was given crystalloids/colloids and later started on dopamine infusion. She was intubated in view of deteriorating general condition and hemodynamic instability. She was managed as per the guidelines of dengue shock syndrome after which her hemodynamic status improved but bleeding continued for which she received 16 units of platelet concentrate, 1 unit aphaeresis along with 4 units of FFP and 1 unit cryoprecipitate in view of deranged coagulation profile. Platelet count remained less than 10,000 / mm3 despite platelet transfusion. Despite all these measures her bleeding continued thus a trial of activated factor VII 90 ug/kg two doses 1 hour apart was given but still bleeding persisted. KhamRho IV Anti D®50ug /kg single dose was administered after which child blood pressure stabilized and bleeding stopped after 3 hr. Platelet counts improved and she was gradually weaned off the inotropes and ventilatory support. Conclusion: The response observed in these patients demonstrates that the massive bleeding due to thrombocytopenia associated with DHF responds rapidly to treatment with IV Anti-D. There were no serious adverse events observed in both the patients.

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