Background and Objective:While medical fraternity globally recognizes the role of platelet transfusion in the management of hospitalized dengue patients the exact indications and situations in which these are to be transfused may vary. Since there is inherent risk associated with the transfusion of blood/blood-component, it is imperative for each institution (or country) to lay their own criteria for transfusion of these blood components. The present study was conducted to lay precise criteria and transfusion trigger for platelet transfusion in our set-up.Materials and Methods:The present study was conducted on 225 serologically confirmed dengue patients admitted at Indraprastha Apollo Hospitals between 1st of August to 30th of November 2005. Clinical data, reports of hematological investigation, platelets requirements and data obtained from daily follow-up were analyzed. The clinicians followed the guidelines issued by the Directorate of Health services, NCT of Delhi.Results:In the serologically confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/cumm) was 84.88% on admission and bleeding was recorded in 22 (9.7%) patients. About 96 (42.6%) patients of dengue cases received platelet transfusion. Among them 47 (20.88%) patients had a platelet count < 20,000/cumm, 43 (19.11%) had a platelet count in the range of 21-40,000/cumm while 6 (2.66%) patients had the platelet count in between 41 and 50,000/cumm. Out of 49 patients with a platelet count >20,000/cumm, 18 patients had haemorrhagic manifestations such as petechiae, gum-bleeding, epistaxis, etc., which necessitates the use of platelet transfusion. However, 31 patients received inappropriate platelet transfusion.Conclusion:This study suggests that bleeding occurs more often in patients with severe thrombocytopenia. High-risk patients having platelet count < 20,000/cumm and risk of bleeding require urgent platelet transfusion. Patients with platelet count 21-40,000/cumm are in moderate risk and require platelet transfusion only if they have any haemorrhagic manifestations and other superadded conditions.

Background Many centres provide D-mismatched platelet transfusions. Platelet concentrates may contain enough red cells leading to the formation of anti-D antibody in D-negative recipient. In resource-poor settings, random donor platelet concentrate (RDPC) is used often and carries higher risk of alloimmunization. At our institution, platelets are transfused across the ABO and Rh blood group barrier without any RhIG immunoprophylaxis. In this study, we retrospectively appraised alloimmunization after D-positive platelet transfusion in D-negative patients. Materials and MethodsSingle-centre 5-year data were collected from Hospital Information System (HIS) for D-negative patients who received D-positive platelet transfusions. Naive patients who had neither pre-existing antibody nor received D-positive platelet transfusion before admission were included. Those who had repeat antibody screening at least 28 days after D-positive platelet transfusion were considered.Results A total of 332 D-negative patients who received 1996 D-positive platelet transfusions were analysed. Median follow-up was 7 weeks (range = 4-90). Anti-D was detected in three (0Á9%) D-negative patients at 5, 8 and 24 weeks after receiving D-positive platelet transfusions. Two of these patients received RDPCs and one received both RDPCs and single donor platelet concentrates.Conclusion D-positive platelet transfusion to D-negative patients seems an acceptable practice as only 0Á9% patients developed anti-D antibody.

Aims and Background:Like any other drug, therapeutic use of fresh frozen plasma (FFP) has its own side effects, adverse reactions and risks involved. Overall use of FFP has been on the increase in most tertiary care hospitals. Since the guidelines for FFP use in a clinical setting are not well defined, the present study aims at defining the appropriateness of use of FFP in the light of its risks and benefits as a drug.Materials and Methods:We carried out a prospective survey of 821 transfusion orders for 2,915 units of fresh frozen plasma components in our hospital over a 4-month period and recorded indication for transfusion and the number of components requested.Results:Five hundred seventy-three (69.8%) of transfusion requests affecting 2,202 (75.54%) units of FFP were appropriately indicated, while 248 (30.2%) of FFP requests were inappropriately indicated. The majority of fresh frozen plasma requests used were for surgical bleeding (22.77%) because of the deranged coagulation profile before surgery in most of the patients. It was followed by liver disease and transplantation (12.54%). Out of 821 patients, 586 were male and 235 were female.Conclusion:Inappropriate requests accounted for 30.2% of the total FFP requests in patients who had normal coagulation parameters. Regular audits, appropriate training of medical staff, conducting regular CMEs are the measures being incorporated in our hospital to rationalize the use of blood components.

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