Think About Possibilites of Dengue Infection Before You Play Your Surgery Knife (Think About Possibilities of Dengue Infection Before We Agree To Do The Operation)
Think About Possibilites of Dengue Infection Before You Play Your Surgery Knife (Think About Possibilities of Dengue Infection Before We Agree To Do The Operation)
Taufiq Muhibbuddin Waly / Poster Presentation
Internal Medicine Departement Waled General Hospital, Cirebon, West Java, Indonesia
Aim :
As a matter of consideration for internist in answering question of operation consultation
Shows the comparison between Hematocrit and Hemoglobin (Ht/Hb) more than 3x can be considered as a sign of Dengue Infection without symptoms (no sickness) in a person.
Case Report:
An obese women (Height: 165 cm, BW: 78 kg), Registration Number 184982. With FA Mammae measurement: 4x5x2 cm, operated in May 8th 2012 as 1 PM.
Laboratory result before operation:
| · Hb: 11.3 | · Natrium: 138 |
| · Ht: 35 | · Kalium 4.3 |
| · Leukocyte: 6300 (0/0/0//52/42/6) | · Chloride: 109 |
| · Platelet: 296000 | · GOT/GPT: 16/17 |
| · Erythrocyte: 4.8 | · Ureum/creatinin: 15/0.7 |
| · LED: 24 (0-10) | · Total Cholesterol: 218 |
| · Clotting Time: 7 | · LDL: 146 |
| · Bledding Time: 2 | · Triglyceride: 70 |
| · Blood Sugar random: 101 mg% | · HDL: 58 |
In May 9th 2012 at 10 AM, patient was shocked, blood pressure 80/ palpation, RR: 28x/minute, HR: 140x/ minute, T:38,9o C, RL: (+), bleeding (-), Laboratory test: Hb: 9.0, Leucocyte 18100, (0/0/0/95/2/3), trombocyt 35000, admitted to ICU, because the shock couldn’t be stopped even after she was given 5 bags of Ringer Lactate liquid and 1 bag of Widahees colloid liquid. Patient was consulted to an internist. During treatment, platelet count even reached as low as 27000 and could only reach 100.000 on the 10th day of treatment. Patient was sent back on 11th day with good overall condition, platelet count was 109000, and underwent Dengue blot inspection again with the result of IgG(+), IgM(-). During treatment the patient was never given any transfusion.
Discussion:
Fever, with positive Rumple leed test, severe thrombocytopenia, shock and Dengue blood IgG(+) on the 11th day showed us the diagnosis of said patient was severe Dengue (WHO 2009) or grade IV DHF (WHO 1997). So when patient underwent operation in May 8th 2012 she had been already infected by Dengue even if it’s still without any symptoms. Laboratory test showed no abnormalities except LED ↑, hypercholesterolemia and Ht/Hb > 3x. Increased LED can be caused by hypercholesterolemia. Ht/Hb > 3x, can be caused by deficiency in intravascular fluid. As the biggest Dengue hyperendemic region, deficiency of intravascular fluid can be considered as caused by Dengue infection at the bottom of the iceberg. Rumple leed test need to be done. Patients who are suspected to be infected by Dengue virus, their operation needs to be postponed if we learned something from this case.
Filed under Artikel 42 - Think About Possibilites of Dengue Infection Before You Play Your Surgery Knife (Think About Possibilities of Dengue Infection Before We Agree To Do The Operation) : Comments (0) : Jun 19th, 2016