The Correlation Between Blood Parameters as Early Detection on Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) in Children

Background: Dengue Shock Syndrome (DSS) is a severe manifestation of Dengue Hemorrhagic Fever (DHF) and affects more children and young adults. The age of susceptibility to DSS is 5-15 years old, due to an imperfect immune system. DHF patients with manifestations of DSS have propensity that can affect the platelet and hematocrit values as an initial laboratory parameter. Objective: This study is intended to find out the most effective platelet and hematocrit blood parameters and to find the correlation between platelet values and hematocrit on the incidence of DHF in Wirosaban Hospital of Yogyakarta Municipality in the period f March 2015 to July 2016. The data used were secondary data from medical records of pediatric patients aged 5-15 years old. Material and Methods: The research method used was to determine the correlation between platelet values and hematocrit on the incidence of DHF and DSS in children. Data analysis used chi-square to determine the correlation between platelet values and hematocrit on the incidence of DHF and DSS in children. Results and Discussion: In this study, the number of samples that fulfilled the inclusion and exclusion criteria was 74 on platelet examination while in the hematocrit examination there were 77 that met the criteria. The results of chi-square test for platelet examination obtained p value> 0.05, which means there was no significant correlation between platelet counts and the incidence of DHF, DHF grade II, and DSS. The results of the chi-square test analysis on hematocrit examination obtained p <0.05, which means that there was a significant correlation between hematocrit values and the incidence of DHF and DSS and it obtainedd r = 0.707. Conclusions: In this study the increase in hematocrit is one of the parameters to detect DHF with propensity to DSS.

and attacks more children and young adults 1 .Dengue fever outbreaks are Indonesia's serious public health problems in tropical rain and equatorial areas where Aedes aegypti is prevalent in urban and rural areas. The growing number of dengue cases is closely linked to the increase in the mosquito population, especially when it rains a lot. High rainfall rates also cause mosquito population's growth 7 . In children, the immune response to dengue virus infection is not perfect so the end result of infection is a sudden increase in permeability of blood vessel walls due to the permeation of blood plasma and electrolytes through the endothelial wall of blood vessels and into the interstitial space, causing hypotension, hemoconcentration, hypoproteinemia and fluid effusion into the serous cavity which is believed to be one of the causes DSS in children patients. To predict which dengue hemorrhagic fever patients will develop into shock is not natural 2 . DHF is an endemic disease over every year in themunicipality of Yogyakarta.

Study Design and Subjects
This research was an analytical retrospective study with cross-sectional design.

Discussion:
The increase in dengue cases is influenced by climatic factors such as temperature, humidity, number of rainy days and rainfall. The high rainfall, rainy days, and temperature of Yogyakarta municipality are directly proportional to the increase in dengue cases where mosquito larvae develop during the incubation period in the temperature range of 15° C to 30° C 4 . In addition, an increase in dengue cases is influenced by behavioral factors and community participation that are still lacking in terms of mosquito nest eradication activity The population and the increased population mobility and transportation facilities make the dengue fever virus easier and broader to spread.Ministry of Health of Indonesia makeit, (2016) 5 . All of these factors can affect the higher cases of DHF. DHF is a severe form of DF (dengue fever) with clinical symptoms such as a fever that lasts 2-7 days with a biphasic pattern or commonly called a horse saddle pattern, bleeding as evidenced by tests, hematemesis (melena), thrombocytopenia (100,000 cells / mm3 or less), and there is a plasma leak that will cause an increase in hematocrit levels 6,8 . In children, the risk of getting DHF is very high with secondary infection of 10 times more than primary infection. Children are more affected by dengue and it even continues to DSS because immunity in children is not as strong as adults and also environmental factors greatly affect this incident where children play in places that are humid, dark, and smelly and where there are mosquito nests. plasma to seep out of the blood vessels. If the plasma continues to seep out of the blood vessels, it will cause an increase in hematocrit levels. If the elevated hematocrit level is not treated immediately, it will cause DSS where the hematocrit level is > 20% from normal levels. If the hematocrit level> 60%, it can cause death 13 .
One of the parameters used in the treatment of DHF is hematocrit levels. Increased hematocrit levels are very dangerous because this can be an indication that the body is in an unstable state. Hemoconcentration occurs due to increased blood cell levels and due to plasma leakage which will cause the body to dehydrate because the plasma component is 90% water 14 . The researchers choose to take the highest hematocrit levels in patients with DHF and DSS during treatment. From these data, there is value of p< 0.05, which means that hematocrit levels have a significant correlation with the incidence of DHF and DSS, this is strengthened by the value of r = 0.707, which means that they have a strong correlation. Hematocrit levels on children and adults are different. Children have hematocrit levels greater than adults. Hematocrit levels in women are also lower than in men. The fever can cause the body to become dehydrated. If dehydration is severe, it will cause hematocrit levels to rise. If the hematocrit level> 60% will cause spontaneous blood clots that will cause death 15 . The results of this study compared with research of Nurhayati 16. The study finds that the peak levels of hematocrit has a significantly correlation with the incidence of DHF. The results of this study different from Utami 9 . The results show that hematocrit levels do not have a significant correlation with the incidence of DHF. In the results of Syumarta 17-18 study of the correlationof initial hematocrit levels to the incidence of DHF, there are no significant results between hematocrit levels and incidence of DHF. According to the three previous researches, it shows that shows that hematocrit levels are not related to the degree of DHF infection, but the hematocrit peak level has a significant correlation with the incidence of DHF. Hematocrit levels can be a determinant of a body condition and determinant in the therapy is givenso that the healing process can be maximized.

Conclusion:
Platelet values do not have a significant correlation with the incidence of DHF and DSS but hematocrit values have a significant correlation to the incidence of DHF and DSS.