Prophylactic Platelets in Dengue: Survey Responses Highlight Lack of an Evidence Base

Abstract

Dengue is the most important arboviral infection of humans. Thrombocytopenia is frequently observed in the course of infection and haemorrhage may occur in severe disease. The degree of thrombocytopenia correlates with the severity of infection, and may contribute to the risk of haemorrhage. As a result of this prophylactic platelet transfusions are sometimes advocated for the prevention of haemorrhage. There is currently no evidence to support this practice, and platelet transfusions are costly and sometimes harmful. We conducted a global survey to assess the different approaches to the use of platelets in dengue. Respondents were all physicians involved with the treatment of patients with dengue. Respondents were asked that their answers reflected what they would do if they were the treating physician. We received responses from 306 physicians from 20 different countries. The heterogeneity of the responses highlights the variation in clinical practice and lack of an evidence base in this area and underscores the importance of prospective clinical trials to address this key question in the clinical management of patients with dengue.

Physician Survey to Determine How Dengue Is Diagnosed, Treated and Reported in Puerto Rico

“…In summary, our survey suggests that despite dengue being endemic in Puerto Rico for more than 40 years, physicians' diagnosis and clinical management of dengue in Puerto Rico are not optimal. As other dengue endemic countries have reported similar findings, a sustained continuing medical education training initiative may be necessary to improve case detection and clinical management even in countries where the disease is common [25] , [28] . Findings from this survey were used to develop and implement a post graduate clinical management course attended by more than 8,000 physicians licensed to practice in Puerto Rico in 2010 and create an on-line version of the course that was released in March of 2014.…”

“…Despite a lack of evidence, many of our survey respondents reported giving prophylactic platelet transfusions to their patients with dengue; a practice that may be relatively common among physicians in dengue endemic countries [25] , [28] . Several studies have found no correlation between platelet count and bleeding or bleeding severity in patients with dengue, and when given, prophylactic platelet transfusions do not expedite platelet recovery [29] – [32] .…”

Efficacy & safety of Carica papaya leaf extract (CPLE) in severe thrombocytopenia (≤30,000/μl) in adult dengue – Results of a pilot study

“…Although thrombocytopenia is a distinct feature of dengue, there is no direct correlation between the extent of platelet loss and incidences of bleeding manifestations [23,24]. According to the guidelines of NVBDC, Directorate General of Health Services, Ministry of Health & Family Welfare (2008) [25], Government of India, use of platelet transfusions to manage severe thrombocytopenia is not recommended even at a platelet count of <20 × 10 3 /μl.…”

Management of Severe Malaria and Severe Dengue in Resource-Limited Settings

“…However, vasculopathy is a central and important additional contributor to the bleeding risk [3]. Prophylactic transfusion of platelets is a common practice in dengue-endemic countries [40]. Platelet transfusion is not without risks, since it can cause allergic reactions and transmission of blood-borne pathogens.…”