Effect of Red Blood Cell Glucose-6-Phosphate Dehydro genase Deficiency on Patients with Dengue Hemorrhagic Fever

VORAVARN S. TANPHAICHITR,M.D.,M.S.*, RACHANEEKORN CHONLASIN, M.D.*, LERLUGSN SUWANTOL, B.Sc.*, PARICHAT PUNG-AMRITT, B.Sc.*, KALAYA TACHAVANICH, M.Sc.*, SUTHEE YOGSAN, M.D., Ph.D.**, VIP VIPRAKASIT, M.D.*,***

Affiliation : * Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, ** Center for Vaccine Development, Institute of Science and Technology for Research and Development, Mahidol University, Nakhon Pathom 73170, Thailand. *** MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, UK.

AbstractEighty nine males aged 1-13 years diagnosed with dengue haemorrhagic fever (DHF) and admitted to the Department of Pediatrics Siriraj Hospital from March 1998 to April 2000 were included in this study. 17 cases (19.1%) had red blood cell glucose-6-phosphate dehydrogenase (G-6- PD) deficiency and 72 cases (80.9%) had normal G-6-PD enzyme activities. Most of the patients were classified as DHF grade II in severity. 3 of 17 G-6-PD deficient cases had serious compli cations and all of them had acute intravascular hemolysis requiring blood transfusions. One of these also had hematemesis, one had azothemia and the other one had renal failure and severe liver failure with hepatic encephalopathy.
In the cases without obvious hemolytic or hepatic complications, G-6-PD deficient cases had mildly but significantly higher total birirubin and indirect bilirubin, as well as a lower hema tocrit than those who had normal G-6-PD. Reticulocyte count was low during the acute phase, however, during recovery, the levels were significantly increased in both groups. In the non G-6-PD deficient group, G-6-PD enzyme levels were significantly decreased during the acute phase com pared to the normal controls but rose significantly to normal levels during the recovery phase. There were no statistically significant differences in other laboratory data. All patients recovered fully from DHF.
The prevalence of G-6-PD deficiency in male patients who had DHF in this study was 19.1 per cent which was higher than the prevalence in a previous study of 12 per cent in Bangkok. This may imply that G-6-PD deficient males suffer more from DHF compared to normal G-6-PD subjects.

Keywords : G-6-PD Deficiency, Dengue Hemorrhagic Fever, Liver Failure, Acute Hemolysis

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