**Abbreviations**



extravasation in patients with DHF/DSS [147]. Hottz et al. demonstrated that DENV-infected patients who showed signs of increased vascular permeability demonstrated a higher percentage of platelets and platelet-derived microparticles (MP) expressing IL-1β and caspase-1 activator compared to patients who had no evidence change in vascular permeability. These results were confirmed in experiments in which platelet-derived MPs exposed to DENV caused an increase in the permeability of endothelial cells that was blocked by IL-1Ra [127]. More recently, proteome analysis related to platelet activating signaling from platelets from dengue patients demonstrated an increase of PAR-4 (F2RL3), G protein subunits (GNA12 and GNA14), and p38 MAPK (MAPK14), in which potentially contributing to increased platelet activation during dengue infection. Moreover, dengue patients had increased P-CD62 surface expression on platelets from patients presenting dengue with warning signs and severe dengue syndromes compared to mild dengue. In agreement, they observed exhaustion of the granule-stored chemokine PF4/CXCL4 in platelets from patients with dengue [148], similarly to another study reported that patients with severe dengue have lower levels of PF4/

Platelets are cellular fragments derived from hematopoietic precursors megakaryocytes, primarily associated with coagulation and hemostasis and also with inflammation, immune response, angiogenesis, and extracellular matrix synthesis. In fact, platelets contain several preformed molecules, large amounts of mRNA, and the packaged translational process required to synthesize new biologically active proteins, including growth factors, cytokines, and chemokines. Platelets are one of the major cell populations affected in dengue, once both thrombocytopenia and platelet dysfunction are common manifestations of infection and strongly related to the patient's clinical outcome. Dysfunction of platelets is implicated in prothrombotic complications associated with severe cases of dengue. Thus, platelets could be considered cells that are active against the anti-DENV immune response, and therefore,

thrombocytopenia is a key prognostic factor in the immunopathogenesis of dengue.

CXCL4 in plasma when compared to mild dengue patients [149].

**4. Conclusion**

18 Thrombocytopenia

**Abbreviations**

DENV dengue virus

prM pre-Membrane NS nonstructural

E envelope M membrane

C capsid


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