Effectiveness of Platelet Transfusion in Dengue Fever: A Randomized Controlled Trial

Abstract

Background: Scientific data regarding effects of platelet transfusion on platelet count in dengue-related thrombocytopenia is scanty. Methods: A single center, randomized non-blinded trial was conducted on adult patients with dengue fever and platelet counts less than 30,000/μl. Patients were randomized to treatment and control group. Treatment group received single donor platelets. Patients with post-transfusion platelet increment (PPI) ≥10,000/μl and/or corrected count increment (CCI) ≥5,000/μl 1 h post-transfusion were considered responders. Primary outcome was platelet count increments at 24 and 72 h. Results: 87 patients were enrolled, and 43 (48.2%) received platelet transfusion. Mean PPI and CCI at 1 h post-transfusion in the treatment group were 18,800/μl and 7,000/μl respectively. 22 (53.6%) patients in the treatment group were non-responders. Mean platelet increments at 24 and 72 h were higher in the treatment group as compared to the control group. Responders showed significantly higher increments when compared to non-responders and the control group at 24 h (p = 0.004 and p < 0.001, respectively) and 72 h (p = 0.001 and p < 0.001, respectively). Significant differences were found between non-responders and the control group at 24 h (p < 0.001), but not at 72 h (p = 0.104). Patients with lower baseline platelet count were more likely to be non-responders. Platelet transfusion neither prevented development of severe bleeding nor shortened time to cessation of bleeding. Three severe transfusion reactions and two deaths occurred in treatment group. Conclusion: In this trial, almost half the patients showed no response to a high-dose platelet transfusion. Platelet transfusion did not prevent development of severe bleeding or shorten time to cessation of bleeding and was associated with significant side effects. Therefore, platelet transfusion should not be routinely done in the management of dengue fever.

Guidelines for the use of platelet transfusions

“…A large observational study of critically ill patients showed that 9% (169/1923) of all critically ill patients received platelet transfusions and 55% (296/534 units) of these were given on days when no significant bleeding occurred (Stanworth et al , ). The optimal platelet transfusion management of these patients (Lieberman et al , ) may differ depending upon the underlying clinical diagnosis (Assir et al , ).…”

Rationale Use of Platelet Transfusion in Dengue Fever-Experience From a Tertiary Care Hospital

“…1 So, multiple platelet transfusions, irrespective of appropriate indications can put the patient in serious transfusion-induced complications such as febrile non-haemolytic transfusion reactions, bacterial sepsis, transfusion-related acute lung injury, allergic reactions, alloimmunization, and platelet refractoriness, pulmonary oedema and transfusion transmitted infections. 7,15 Khan Assir et al also revealed that Platelet transfusion despite increasing platelet count in half the recipients neither stopped the progression to severe bleeding nor shortened the time to cessation of bleeding. This proves that a high baseline platelet count and a successful platelet transfusion cannot prevent progression to severe bleeding.…”

“…This proves that a high baseline platelet count and a successful platelet transfusion cannot prevent progression to severe bleeding. 15 Blood transfusion services constantly face challenges year after year during dengue outbreaks due to lack of evidencebased guidelines for clinical use of blood and blood components. The demand for platelets and Fresh frozen plasma is increasing due to more number of cases with dengue haemorrhagic fever and dengue shock syndrome.…”

Comments on the clinical and laboratory characteristics of patients with dengue hemorrhagic fever manifestations and their transfusion profile**See paper by Fujimoto DE et al. on pages 115-20.

“…Several studies have shown that there is a correlation between the bleeding degree and the platelet count 13., 14., 15.. The prevention of bleeding in DHF should be directed to the early recognition of shock and immediate correction with PC of and/or fresh frozen plasma (FFP) transfusions 13., 16., 17..…”

“…Several studies have shown that there is a correlation between the bleeding degree and the platelet count 13., 14., 15.. The prevention of bleeding in DHF should be directed to the early recognition of shock and immediate correction with PC of and/or fresh frozen plasma (FFP) transfusions 13., 16., 17.. The monitoring of hematocrit in series, which reflects the degree of plasma leakage, at the expense of monitoring thrombocytopenia and coagulopathies results in a reduction in the use of blood products 17 .…”