A hypothetical intervention to reduce plasma leakage in dengue haemorrhagic fever.

ABSTRACT

Plasma leakage from increased vascular permeability, if left unattended, will lead to intravascular volume depletion. The ensuing tissue hypoperfusion and the consequent life-threatening complications may have a fatal outcome in dengue haemorrhagic fever (DHF). Although an accurately calculated volume of fluid infused during the critical phase of plasma leakage can prevent such an eventuality, the practical difficulties in its execution with properly-timed adjustments to the fluid infusion rate and the aggressive monitoring needed during this phase of the illness can limit the expected benefits of an exclusively fluid-based regime. An intervention to reduce plasma leakage in DHF complementing the standard fluid regime conceivably would improve the outcome. It is my hypothesis that fresh frozen plasma (FFP) by Fc receptor blockade and the associated reduction in immune-enhanced viral replication could reduce cytokine-mediated increase in vascular permeability. Additionally, albumin in FFP, by adhering to the glycocalyx, could further compromise fluid fluxes during the critical phase of DHF. However, this hypothesis needs to be tested by a randomized controlled study.