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Figure 1

A. Posterior–anterior chest X-ray image demonstrating a slight radiographic sign that suggests interstitial pulmonary edema. B. Supine radiogram demonstrating redistribution of lung circulation from base to middle, suggestive of pulmonary congestion. C. Endotracheal tube inserted after persistent pulmonary congestion. D. Posterior–anterior chest X-ray image showing with normal lung marking and heart size.
A. Posterior–anterior chest X-ray image demonstrating a slight radiographic sign that suggests interstitial pulmonary edema. B. Supine radiogram demonstrating redistribution of lung circulation from base to middle, suggestive of pulmonary congestion. C. Endotracheal tube inserted after persistent pulmonary congestion. D. Posterior–anterior chest X-ray image showing with normal lung marking and heart size.

Figure 2

A. Peripheral blood smear during febrile phase showing normochromic and normocytic red blood cells, white blood cells with predominating lymphocytes and atypical lymphocytes, with slight thrombocytopenia. B. Peripheral blood smear (during shock stage with intractable bleeding on the first week of hospitalization) showing a decreased number of red blood cells with nucleated red blood cells, and a scanty number of platelets. C. Peripheral blood smear on the second week of hospitalization, showing microspherocytes, polychromasia of red blood cells with predominating polychromatosis, white blood cells, and platelets within normal reference ranges. D. Peripheral blood smear during recovery phase showing red blood cells, white blood cells, and platelets within normal reference ranges. All micrographs are shown with Wright–Giemsa staining (original magnification×1000). Scale bars indicate 10 μm.
A. Peripheral blood smear during febrile phase showing normochromic and normocytic red blood cells, white blood cells with predominating lymphocytes and atypical lymphocytes, with slight thrombocytopenia. B. Peripheral blood smear (during shock stage with intractable bleeding on the first week of hospitalization) showing a decreased number of red blood cells with nucleated red blood cells, and a scanty number of platelets. C. Peripheral blood smear on the second week of hospitalization, showing microspherocytes, polychromasia of red blood cells with predominating polychromatosis, white blood cells, and platelets within normal reference ranges. D. Peripheral blood smear during recovery phase showing red blood cells, white blood cells, and platelets within normal reference ranges. All micrographs are shown with Wright–Giemsa staining (original magnification×1000). Scale bars indicate 10 μm.

Progression of an autoimmune hemolytic anemia that developed during severe dengue infection

Characteristic Day of hospitalization and follow-up

D1 D3 D5 D7 D9 D11 D13 D21 (D/C) D30 (OPD) D90 (OPD)
Body temperature (°C) 39.0 41.0 38.5 38.6 37.5 37.0 37.4 36.8 NA NA
Pulse pressure 24 22 59 55 55 53 53 41 54 48
Bleeding site
Hemoptysis ++ +++
Ecchymosis ++ ++ ++ + +
Hematuria + +
CBC
Hemoglobin (g/dL) 15.8 10.9 9.5 10.5 10.1 9.1 8.7 10.0 12.6 14.4
White blood cells count (cells/mm3) 3,500 3,600 5,000 4,700 5,300 4,500 5,200 4,200 4,700 6,000
Platelet count (cells/mm3) 15,000 13,000 17,000 87,00 90,00 99,00 117,000 190,000 182,000 165,000
LFT
AST (U/L) 2,476 7,425 NA 2,587 NA 386 NA 215 65 NA
ALT (U/L) 1,273 2,125 NA 1,072 NA 355 NA 218 105 NA
DCT NA ++ +
Medication
rVIIa 1st time 2nd time
Carbapenam + + + + +
Blood component transfusion
LPRC 1 6 1
LPPC/SDP 1/0 3/1 1/0
FFP 3
Cryoprecipitate 10
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