Dengue hemorrhagic fever (DHF) causing by
dengue viral infection is endemic in Thailand and Southeast Asian countries where
thalassemias are prevalent. Thalassemic patients are also at risk to acquire
dengue viral infections and to develop DHF. However, they can have different clinical manifestations and complications as well as more severity than general population requiring special awareness for proper diagnosis and management. We reported 20 thalassemic patients (10 boys and 10 girls) with DHF admitted to Department of Pediatrics, Siriraj Hospital during 1977 to 2001. Their ages ranged from 2-16 years (average 9.5 years). These cases included 5 cases of Hb H disease, 5 cases of Hb H with
Hb Constant Spring (CS), 9 cases of
beta-thalassemia/Hb E disease and 1 case of
beta-thalassemia major. Two cases were in Grade I, 10 cases in grade II, 7 cases in Grade III and one case in grade IV severity of DHF. Though there were evidences of plasma leakage, instead of hemoconcentration, eighteen patients (90 percent) had hematocrit dropped at the range of 11-66% of the initial level. Fifteen patients (75 percent) required at least one packed red cell transfusion. Nine patients (45 percent) had mild
bleeding symptoms, one of them had upper
gastrointestinal hemorrhage requiring platelet concentrate transfusion. Two patients (10 percent) had serious complications including one with
infection-associated hemophagocytic syndrome (
IAHS) requiring
intravenous immunoglobulin (
IVIG) and packed red cell transfusion and the other had
generalized seizure due to
hyponatremia and
hypotension. No mortality was observed among this group of patients. Early recognition of the DHF in thalassemic patients and appropriate packed red cell transfusion in patients with anemic symptoms is warranted to reduce morbidity and mortality in these patients.