Prothrombin Fragments 1.2 in Relation with Plasma Leakage and Thrombocytopenia in Dengue Infection

Clinical manifestations of dengue hemorrhagic fever are plasma leakage and thrombocytopenia. Both manifestations are thought to be caused by increased thrombin generation as a result of coagulation activation. During thrombin generation, prothrombin fragment 1.2 (F1.2) was cleavaged from prothrombin molecule. The aims of this study were to look for any association between F1.2 level with plasma leakage, to know whether F1.2 level in critical phase was higher than that in convalescent phase, and to search any correlation between F1.2 level and platelet count in dengue infected patients. This cross sectional study have been approved by the ethics committee of Medical Faculty, Universitas Indonesia. Twenty subjects consisted of 10 subjects with plasma leakage and 10 subjects without plasma leakage, who agree to participate by signing the informed consent were enrolled in this study. Plasma leakage was defined by at least one of these things : increased hematocrit [greater than or equal to] 20% from reference value or a decrease in hematocrit [greater than or equal to] 20% after fluid replacement therapy, or evidence of pleural effusion and/or ascites, and/or by albumin >3.5 g/dL. Six pairs samples were used for comparison of F1.2 level in critical phase and convalescent phase, and 26 samples were used for correlation between F1.2 and platelet count. Recruitment of subjects were done from January until September 2013. F1.2 level was determined by ELISA. The results showed that F1.2 level in patients with plasma leakage (147 [+ or -] 105.82 pg/mL) was significantly higher than that in patient without plasma leakage (53.6 [+ or -] 63.32pg/mL). F1.2 level in critical phase (186.3 pg/mL) was significantly higher than that in convalescent phase (46.5 pg/mL). There was a negative correlation between F1.2 level and platelet count (r=0.609). The results of this study suggested that at critical phase of dengue infection, activation of coagulation occurred which was associated with plasma leakage and thrombocytopenia.