Effects of Filgrastim on Thrombocytopenia in Patients with Dengue Fever: A Retrospective Study

Authors:

Deepak D Baid* and Vivika Jain

Volume 2, Issue 7

Abstract

Background: Dengue infection causes hematological disturbances including agranulocytosis, leucopenia, and thrombocytopenia. Platelet transfusion is generally used for hematological corrections, but they are not always useful, and are expensive too. Filgrastim is effective in mobilizing the progenitor cells to stimulate the production of platelets and white blood cells (WBCs) endogenously. Aims: This observational, retrospective, single-center study aimed to evaluate the effects of filgrastim in improving platelet and WBC counts in patients with dengue fever. Methods: Data of patients with dengue fever admitted to Nulife Hospital, Mumbai, who had received filgrastim (Neukine®), were analyzed. Dengue was diagnosed by the rapid dengue NS1 antigen and dengue IgM/IgG antibody tests. Patients with severe thrombocytopenia (platelet count : <20000/mm3 with or without bleeding) were given a single subcutaneous dose of filgrastim 300 μg/mL. Patients with dengue hemorrhagic fever and dengue shock syndrome were excluded. Results: Data of 51 patients with dengue fever with thrombocytopenia, or dengue like fever with thrombocytopenia (patients in whom reduction in fever followed by leucocytes and platelets were observed) analyzed. Majority (56.86%) had severe thrombocytopenia (platelet count: <20000/mm3) at baseline. A significant increase (p<0.001) was observed in the platelet and WBC counts on Days 1 and 2 after filgrastim administration. Doubling of the platelet count was seen in 41 patients within 2 days, and WBC within a day post filgrastim use. Maximum increase (~800%) in platelet count was seen at discharge in patients with baseline platelet count <10000/mm3. Proportion of patients receiving platelet transfusion was lower after filgrastim use than before its administration (9 vs. 22). Filgrastim use was also associated with improvement in the fever status in majority of patients. None of the patients reported any complications after filgrastim use. Liver, renal and hematological evaluations did not show any adverse effects. The follow-up evaluation post discharge was normalization of hematological parameters (as per the clinician), but did not form part of this study.

Conclusion: This is the first study to demonstrate that filgrastim use persistently increases the platelet counts along with white blood cell counts within a day in patients with dengue. Addition of filgrastim to the treatment of dengue may helpin reducing the transfusion requirement and fever episodes, and thus improving the disease outcome. More studies will be required to analyze if there is reduction in bleeding tendency and to confirm the disease outcomes.

Keywords:

Dengue; Fever; Thrombocytopenia; Platelet; White Blood Cell; Filgrastim; Neukine®

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