Table 1: Patients details explain platelet count distribution.

Results

Demographic and Clinical Characteristics

Among the 20 patients analyzed, 60% were male (n=12) and 40% were female (n=8), with a mean age of 30.4 years (range: 19–49 years). Four patients (20%) were recorded as being on the 6th day of fever. The mean platelet count across all patients was 46,285 cells/µL and the mean hematocrit was 37.7%.

Atypical Presentations

Six patients exhibited platelet counts below 25,000 cells/µL without the typical warning signs of severe dengue, such as hemorrhage or plasma leakage. The lowest recorded platelet count was 12,200 cells/µL in two patients, neither of whom presented with significant warning signs.

Statistical Analysis

T-Test: The average platelet count among males (47,264 cells/µL) was not significantly different from females (44,025 cells/µL), with a p-value of 0.72, indicating no gender-based differences.

ANOVA: Significant differences were observed in platelet counts across disease severity levels (p = 0.045). Patients in more severe stages exhibited consistently lower platelet counts.

Pearson’s Correlation: A moderate inverse correlation (r = -0.42) between platelet counts and hematocrit levels was observed, suggesting that as platelet counts drop, hematocrit levels rise slightly. However, this correlation was not statistically significant (p = 0.15).

Discussion

Dengue fever remains a critical public health concern in urban Bangladesh, particularly in Dhaka where dense populations and inadequate vector control facilitate transmission [6]. The findings of this study underscore the importance of vigilant monitoring of platelet counts during the course of dengue infection, particularly around the critical phase on day 6 of illness.

Several patients with severe thrombocytopenia (platelet counts below 25,000 cells/µL) did not exhibit typical warning signs such as bleeding, which highlights the complexity of dengue pathophysiology and the challenge in predicting disease [6]. Similar findings have been reported in other dengue-endemic regions, suggesting that atypical presentations may be more common than previously understood [1]. These cases complicate the clinical decision-making process, as the absence of warning signs may lead to delays in appropriate medical intervention.

The moderate inverse correlation between platelet count and hematocrit levels supports the hypothesis that plasma leakage, which leads to hemoconcentration, may not always be accompanied by dramatic changes in clinical symptoms [7]. Hematocrit monitoring, in conjunction with platelet count, may provide a more reliable indicator of disease progression in these atypical cases.

Conclusion

This study has contributed to a better understanding of the dynamics of platelet count and hematocrit levels in dengue fever patients, particularly in the context of atypical presentations. While platelet count remains a critical marker of disease severity, this research suggests that clinicians should be cautious in relying solely on this parameter, as severe thrombocytopenia can occur without typical warning signs.

Benefits and Recommendations

The findings of this study highlight the need for a multifaceted approach to dengue diagnosis and management. Incorporating regular monitoring of hematocrit levels alongside platelet counts may help clinicians better predict disease severity, even in the absence of typical clinical signs. Further research with larger sample sizes is recommended to validate these findings and refine diagnostic protocols for atypical dengue presentations. Public health strategies should also focus on improved vector control and education to mitigate the rising dengue burden in urban Bangladesh.

Conflict of Interests

The authors have no competing interests that are relevant to the content of this article to declare.

Acknowledgement

Acknowledge those who provided technical support during the study.

Statements and Declarations

All authors had access to the data and a role in writing the manuscript, with no disclaimers and patient consent was obtained.

Financial Disclosure

No funding was not involved in the manuscript writing, editing, approval or decision to publish.

Data Availability

Data Availability Statement: All data generated or analyzed in this study are included in this article. Access to data is possible with permission from the responsible author.

Consent for Publication

Informed consent was obtained from the patient for publication of this case report and is stated in the manuscript.

Authors Contribution

All authors contributed equally to this paper.

References

1. Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, et al. Dengue: a continuing global threat. Nature Rev Microbiol. 2010;8(Suppl 12):S7-16.
2. World Health Organization (WHO). Dengue haemorrhagic fever: diagnosis, treatment, prevention and control. Geneva: World Health Organization. 2009.
3. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504-7.
4. Islam MN, Hossain MA, Khan AA. Dengue fever in Bangladesh: A review of recent trends and challenges. Bangladesh J Med Sci. 2016;15(3):162-9.
5. World Health Organization. Dengue haemorrhagic fever: guidelines for diagnosis, treatment, prevention and control. Geneva: World Health Organization. 2015.
6. Islam MZ, Rahman M, Hossain MA. Clinical manifestations and hematological profile of dengue fever in Bangladesh: A cross-sectional study. J Infect Dis Ther. 2018;6(1):1-7.
7. Alam MA, Islam MS, Rahman MS. Dengue fever in Bangladesh: A review of the current scenario. J Infect Dis Ther. 2020;8(3):432-41.