E-ISSN 2367-699X | ISSN 2367-7414
 

Case Report 


Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series

Kamal Deep Yadav, Harjit Singh Mahay, Ruchi Gupta.

Abstract
Severe Dengue Infection unresponsive to standard therapy carries a very high mortality with limited therapeutic options. Ferritin levels have been evaluated recently for its role as a diagnostic tool in dengue fever. It has also been shown to correlate with severity of dengue. Hyperferritinemia is an important marker for diagnosis of macrophage activation syndrome which is commonly seen in severe dengue. Immunomodulation has been attempted using steroids and IVIG therapy. Both are not recommended therapy for dengue patients of any severity. Treatment guidelines have been developed by World Health Organization(WHO) but there are variations between these guidelines. There are no robust trials and studies about use of plasmapheresis in Severe Dengue. High Volume Plasma Exchange(HVP) in acute hepatic failure have been well studied in recent randomized controlled trial by Larsen et al with improvement in outcome by increasing liver transplant-free survival further suggesting that the effect is mediated by dampening of innate immune response with Therapeutic plasma exchange(TPE). TPE has been attempted in patients of dengue with Hyperferritinemia associated multiorgan failure with variable success.WHO SEARO (World Health Organization in South-East Asia) guidelines recommends considering plasma exchange as a therapeutic option for management of severe dengue patients with hepatic encephalopathy who are clinically deteriorating with standard treatment. Based on the data by Larsen and WHO SEARO guidelines we instituted Plasmapheresis in severe dengue patients who were clinically unresponsive to standard therapies and were deteriorating.

Key words: Hyperferritinemia, Plasmapheresis, Severe Dengue


 
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How to Cite this Article
Pubmed Style

Yadav KD, Mahay HS, Gupta R. Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. Int J Surg Med. 2019; 5(2): 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure


Web Style

Yadav KD, Mahay HS, Gupta R. Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. http://www.ejos.org/?mno=21026 [Access: August 21, 2019]. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure


AMA (American Medical Association) Style

Yadav KD, Mahay HS, Gupta R. Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. Int J Surg Med. 2019; 5(2): 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure



Vancouver/ICMJE Style

Yadav KD, Mahay HS, Gupta R. Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. Int J Surg Med. (2019), [cited August 21, 2019]; 5(2): 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure



Harvard Style

Yadav, K. D., Mahay, . H. S. & Gupta, . R. (2019) Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. Int J Surg Med, 5 (2), 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure



Turabian Style

Yadav, Kamal Deep, Harjit Singh Mahay, and Ruchi Gupta. 2019. Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. International Journal of Surgery and Medicine, 5 (2), 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure



Chicago Style

Yadav, Kamal Deep, Harjit Singh Mahay, and Ruchi Gupta. "Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series." International Journal of Surgery and Medicine 5 (2019), 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure



MLA (The Modern Language Association) Style

Yadav, Kamal Deep, Harjit Singh Mahay, and Ruchi Gupta. "Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series." International Journal of Surgery and Medicine 5.2 (2019), 79-82. Print. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure



APA (American Psychological Association) Style

Yadav, K. D., Mahay, . H. S. & Gupta, . R. (2019) Therapeutic Plasma Exchange as a rescue therapy in three patients of severe Dengue with Hyperferritinemia and acute hepatic failure: A Case Series. International Journal of Surgery and Medicine, 5 (2), 79-82. doi:10.5455/ijsm.severe-Dengue-with-Hyperferritinemia-and-acute-hepatic-failure