Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter December 13, 2019

Dual-frequency bioelectrical phase angle to estimate the platelet count for the prognosis of dengue fever in Indian children

  • Neelamegam Devarasu EMAIL logo and Gnanou Florence Sudha EMAIL logo


A noninvasive investigation to ascertain the platelet (PLT) count was conducted on 44 hospitalized dengue hemorrhagic fever (DHF) subjects, male and female aged between 3 and 14 years using bioelectrical phase angle (BPhA). Among the 44 subjects, 30 subjects were confirmed to be non-structural protein-1 (NS1) positive at the time of admission, whose blood investigations such as hematocrit (HCT) level, PLT count, aspartate aminotransferase (AST) level and alanine aminotransferase (ALT) level were performed for the classification of risk as low-risk (LR) and high-risk (HR) DHF. It was found that the BPhA of the body reflects a linear correlation with the PLT count. To provide a better and more accurate estimate of PLT, a dual-frequency method is proposed to calculate the phase angle of the total body. The resistance at 5 kHz and reactance at 100 kHz were used to estimate the phase angle of the total body. The statistical analysis identified that the PLT count estimated using the proposed dual-frequency method shows a good correlation with the blood investigation results. In addition, statistical analysis of the proposed method on other fever subjects indicated a significant difference with DHF.


The authors wish to thank the Department of Science and Technology (DST), New Delhi, India for providing financial support to the project. (IDP/MED/2012/15 dated 25.3.2014). The Ethics Committee approval code is ECR/324/Inst/PY/2013. We would also like to thank Dr P. Narayanan, Dr R. Sandanalakshmi and Dr R. Soundravally, co-investigators of the DST project, for their immense contributions and help. We also express our thanks to the Director and staff of JIPMER Hospital for their cooperation and support.

  1. Research funding: Authors state no funding involved.

  2. Conflict of interest: Authors state no conflict of interest.

  3. Informed consent: Informed consent has been obtained from all individuals.

  4. Ethical approval: The research related to human use complied with all the relevant national regulations and institutional policies, was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the local institutional review board.


[1] World Health Organization (WHO). Dengue: Guidelines for diagnosis, Treatment, Prevention and Control – New Edition. Geneva, Switzerland: WHO; 2009.Search in Google Scholar

[2] Eggleton MJ, Sharp AA. Platelet counting using the Coulter electronic counter. J Clin Pathol 1963;16:164–7.10.1136/jcp.16.2.164Search in Google Scholar PubMed PubMed Central

[3] Grimnes S, Martinsen OG. Bioimpedance and bioelectricity basics. London, UK: Academic Press; 2015:1–585.10.1016/B978-0-12-411470-8.00001-5Search in Google Scholar

[4] Sutherland PE. Principles of Electrical Safety. Hoboken, NJ, USA: Wiley; IEEE Press; 2015;1–795.10.1002/9781118886397Search in Google Scholar

[5] Klassen P, Mazariegos M, Deurenberg P, Solomons N, Furst P. Hydrational status assessed by bioelectrical impedance spectroscopy and dilution methods in patients with classical dengue fever. Ann NY Acad Sci 2000;904:163–70.10.1111/j.1749-6632.2000.tb06442.xSearch in Google Scholar PubMed

[6] Ibrahim F, Guan CC, Taib MN, Wan Abas WAB. The characteristic hydration status changes by bioelectrical impedance assessment in female dengue haemorrhagic fever (DHF) patients. Med J Malaysia 2002;57:98.Search in Google Scholar

[7] Ibrahim F, Ooi KF, Ismail NA, Taib MN, Wan Abas WAB. Analysis of water compartment in dengue patients. In: Proceedings of the 27th Annual International Conference of the Engineering in Medicine and Biology Society, Shanghai, China 2005:4130–3.10.1109/IEMBS.2005.1615372Search in Google Scholar PubMed

[8] Kamat DK, Bagul D, Patil PM. Classification and applications of bio-impedance measurement techniques. Int J Eng Innov Technol 2014;3:89–91.Search in Google Scholar

[9] Ibrahim F, Ismail NA, Taib MN, Wan Abas WAB. Modeling of haemoglobin in dengue fever and dengue hemorrhagic fever using bioelectrical impedance. Physiol Meas 2004;25:607–15.10.1088/0967-3334/25/3/002Search in Google Scholar PubMed

[10] Rawi AH, Moghavvimi M, Ibrahim W. Novel idea to monitor and measure blood haemoglobin noninvasively. Afr J Biotechnol 2010;9:9295–306.Search in Google Scholar

[11] Ibrahim F, Wan Abas WAB, Taib MN, Guan CC, Sulaiman S. A new approach to classify risk in dengue infection using bioelectrical impedance analysis. Dengue Bull 2007;31:58–74.Search in Google Scholar

[12] Ibrahim F, Taib MN, Wan Abas WAB, Guan CC, Sulaiman S. A novel approach to classify risk in dengue hemorrhagic fever (DHF) using bioelectrical impedance analysis (BIA). IEEE Tran Instrum Meas 2005;54:237–44.10.1109/TIM.2004.840237Search in Google Scholar

[13] Khalil SF, Mohktar MS, Ibrahim F. The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases. Sensors 2014;14:10895–928.10.3390/s140610895Search in Google Scholar PubMed PubMed Central

[14] Ward LC, Dyer JM, Byrne NM, Sharpe KK, Hills AP. Validation of a three-frequency bioimpedance spectroscopic method for body composition analysis. Nutrition 2007;23:657–64.10.1016/j.nut.2007.06.009Search in Google Scholar PubMed

[15] Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gomez JM, et al. Bioelectrical impedance analysis – Part I: Review of principles and methods. Clin Nutr 2004;23:1226–43.10.1016/j.clnu.2004.06.004Search in Google Scholar PubMed

[16] Lukaski HC, Bolonchuk WW. Estimation of body fluid volumes using tetrapolar bioelectrical impedance measurements. Aviat Space Environ Med 1988;59:1163–9.Search in Google Scholar

[17] Lukaski HC, Bolonchuk WW, Hall CB, Siders WA. Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 1986;60:1327–32.10.1152/jappl.1986.60.4.1327Search in Google Scholar

[18] Olde RM, Deurenberg P, Jansen R, Hof MV, Hoefnagels W. Validation of multi-frequency bioelectrical impedance analysis in detecting changes in the fluid balance of geriatric patients. J Am Geriatr Soc 1997;45:1345–51.10.1111/j.1532-5415.1997.tb02934.xSearch in Google Scholar

[19] Segal KR, Burastero S, Chun A, Coronel P, Pierson RN, Wang J. Estimation of extracellular and total body water by multiple-frequency bioelectrical-impedance measurement. Am J Clin Nutr 1991;54:26–9.10.1093/ajcn/54.1.26Search in Google Scholar

[20] Cornish BH, Thomasset BJ, Ward LC. Improved prediction of extracellular and total body water. Phys Med Biol 1993;38:337–46.10.1088/0031-9155/38/3/001Search in Google Scholar

[21] Ibrahim F, Ismail NA, Taib MN, Wan Abas WAB, Sulaiman S, Guan CC. Assessment of haematocrit status using bioelectrical impedance analysis in dengue patients. Melbourne, Australia: IFAC Modelling and Control in Biomedical Systems 2003:277–81.10.1016/S1474-6670(17)33515-2Search in Google Scholar

[22] Libraty DH, Endy TP, Kalayanarooj S, Chansiriwongs W, Nisalak A, Green S, et al. Assessment of body fluid compartment volumes by multifrequency bioelectrical impedance spectroscopy in children with dengue. Trans R Soc Trop Med Hyg 2002;96:295–9.10.1016/S0035-9203(02)90104-5Search in Google Scholar

[23] Fricke H, Morse S. Electric resistance and capacity of blood for frequencies between 800 and 4½ million cycles. J Gen Physiol 1925;20:153–67.10.1085/jgp.9.2.153Search in Google Scholar PubMed PubMed Central

[24] Frewer RA. The effect of frequency changes on the electrical conductance of moving and stationary blood. Med Biol Eng Comput 1972;10:734–41.10.1007/BF02477384Search in Google Scholar PubMed

[25] Zhao TX. New applications of the electrical impedance of human blood. J Med Eng Technol 1996;20:115–20.10.3109/03091909609008389Search in Google Scholar PubMed

[26] Ibrahim F, Thio THG, Faisal T, Neuman M. The application of biomedical engineering techniques to the diagnosis and management of tropical diseases: a review. Sensors 2015;15:6947–95.10.3390/s150306947Search in Google Scholar PubMed PubMed Central

[27] Kumar S, Dutt A, Hemraj S, Bhat S, Manipadybhima B. Phase angle measurement in healthy human subjects through bio-impedance analysis. Iran J Basic Med Sci 2012;15:1180–4.Search in Google Scholar

[28] Gonzalez MC, Silva TGB, Bielemann RM, Gallagher D, Heymsfield SB. Phase angle and its determinants in healthy subjects: influence of body composition. Am J Clin Nutr 2016;103:712–6.10.3945/ajcn.115.116772Search in Google Scholar

[29] Silva MCB, Barros AJ. Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond body composition equations. Curr Opin Clin Nutr Metab Care 2005;8:311–7.10.1097/01.mco.0000165011.69943.39Search in Google Scholar

[30] Mulasi U, Kuchnia AJ, Cole AJ, Earthman CP. Bioimpedance at the bedside: current applications, limitations, and opportunities. Nutr Clin Pract 2015;30:180–93.10.1177/0884533614568155Search in Google Scholar

[31] Norman K, Stobaus N, Pirlich M, Westphal AB. Bioelectrical phase angle and impedance vector analysis – clinical relevance and applicability of impedance parameters. Clin Nutr 2012;31:854–61.10.1016/j.clnu.2012.05.008Search in Google Scholar

[32] Silva MCB, Barros AJ, Wang J. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr 2005;82:49–52.10.1093/ajcn/82.1.49Search in Google Scholar

[33] Dittmar M. Reliability and variability of bioimpedance measures in normal adults: effects of age, gender, and body mass. Am J Phys Anthropol 2003;122:361–70.10.1002/ajpa.10301Search in Google Scholar

[34] Kyle UG, Genton L, Slosman DO. Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years. Nutrition 2001;17:534–41.10.1016/S0899-9007(01)00555-XSearch in Google Scholar

[35] Westphal AB, Danielzik S, Dorhofer RP. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. J Parenter Enteral Nutr 2006;30:309–16.10.1177/0148607106030004309Search in Google Scholar

[36] Oliveira CM, Kubrusly M, Mota RS. The phase angle and mass body cell as markers of nutritional status in hemodialysis patients. J Ren Nutr 2010;20:314–20.10.1053/j.jrn.2010.01.008Search in Google Scholar

[37] Silva MCB, Barros AJ, Post CL, Waitzberg DL, Heymsfield SB. Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment. Nutrition 2003;19:422–6.10.1016/S0899-9007(02)00932-2Search in Google Scholar

[38] Baumgartner RN, Chumlea WC, Roche AF. Bioelectric impedance phase angle and body composition. Am J Clin Nutr 1988;48:16–23.10.1093/ajcn/48.1.16Search in Google Scholar PubMed

[39] Maddocks M, Kon SSC, Jones SE, Canavan JL, Nolan CM, Higginson IJ, et al. Bioelectrical impedance phase angle relates to function, disease severity and prognosis in stable chronic obstructive pulmonary disease. Clin Nutr 2015;34:1245–50.10.1016/j.clnu.2014.12.020Search in Google Scholar PubMed

[40] Stobaus N, Pirlich M, Valentini L, Schulzke JD, Norman K. Determinants of bioelectrical phase angle in disease. Br J Nutr 2012;107:1217–20.10.1017/S0007114511004028Search in Google Scholar PubMed

Received: 2018-10-17
Accepted: 2019-08-30
Published Online: 2019-12-13
Published in Print: 2020-08-27

©2019 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 8.12.2023 from
Scroll to top button