Critical Care Ph Universidad Nacional Autonoma de Mexico, Distrito Federal, Mexico
Introduction: Dengue shock syndrome is a life-threatening condition with a wide variety of manifestations mainly of hematologic origin while Glanzmann's thrombasthenia is a rare primary platelet dysfunction of GIIb/IIIa receptors, infrequent in Mexican population. The case presented combines these two pathologies involving a greater challenge in medical approach
Description: A 29-year-old woman came to the emergency department with headache, fever of 40°C and joint pain with analgesic treatment without improvement of the symptoms. A serological test was performed to detect Dengue virus being positive. With abdominal pain located in the right hypochondrium and mellenic evacuations on physical examination with data of peritoneal irritation and hypotension. An emergency exploratory laparotomy was performed, finding splenic rupture and 3000 milliliters of hemoperitoneum. Splenectomy was performed with persistent bleeding, and she was sent to our hospital for specialized treatment. Admitted to the Intensive Care Unit with double vasopressor support, biochemical hypoperfusion markers, lactate greater than 15 mmol/L, central venous saturation 74%, capillary filling 5 seconds. In blood test hemoglobin 4.2 g/dL, platelets 95 000, INR 2.07, fibrinogen 92 mg/DL, dimer D 1.15 mcg/mL, due to hemodynamic instability, it was decided to resuscitate with blood products and to monitor the patient until conditions improved for surgical reintervention. Serial hemotransfusion guided by viscoelastic tests (ROTEM) was performed, a platelet aggregation deficit pattern was observed despite reaching a platelet count of 185,000, Therefore, primary platelet dysfunction was suspected, platelet aggregometry tests were performed, finding dysfunction in the platelet expression of GIIb/IIIa corresponding to Glanzmann thrombasthenia, and it was decided to start treatment with factor VII before and during surgery achieving correction of acute organ failure
Discussion: The use of viscoelastic test during resuscitation limit the risk of masive transfusions unmasking aggregate pathologies allowing for targeted and individualized treatment
