Unfurling the Rationale Use of Platelet Transfusion in Dengue Fever

Abstract

Dengue fever and dengue haemorrhagic fever have emerged as a global public health problem in recent decades. The practice of platelet transfusion has been adapted into the standard clinical practice in management of hospitalized dengue patients. The exact indications and situations in which platelet have to be transfused may vary greatly. Blood components especially platelet concentrates due to their short shelf life are frequently in limited supply. Hence, appropriate use of blood is required to ensure the availability of blood for patients in whom it is really indicated, as well as to avoid unnecessary exposure of the patients to the risk of transfusion reactions and transmission of blood borne infection. The present study was conducted to evaluate the appropriateness of platelet transfusion done in dengue patients with thrombocytopenia. The present study was conducted on 343 serologically confirmed dengue patients admitted at JSS University Hospital between 1st January and 30th August 2009. Clinical data, platelet count and platelet requirements were analyzed. Among the 343 serologically confirmed cases, the prevalence of thrombocytopenia (platelet count < 100,000/cumm) was 64.72% (222 patients) and bleeding manifestations were recorded in 6.12% (21 patients). 71 (20.7%) patients of dengue cases received platelet transfusion. Among them 34 (47.89%) patients had a platelet count <20,000/cumm, 28 patients (39.44%) had platelet counts in the range of 21-40,000/cumm while the remaining 9 (12.67%) patients had platelet count between 41-100,000/cumm. Out of 37 patients with a platelet count >20,000/cumm 11 patients had haemorrhagic manifestations such as petechiae, gum bleeding, epistaxis etc., which necessitates the use of platelet transfusion. However, the remaining 26 patients with platelet count >20,000/cumm and with no haemorrhagic manifestations received inappropriate platelet transfusion. Transfusion of 36.62% of platelet concentrate was inappropriate. The study emphasizes the need for development of specific guidelines for transfusion of blood components, constant interaction and co-ordination amongst clinicians and transfusion centre for implementation of these guidelines and a regular medical audit to review the optimal utilization of blood components.

Retrospective Review of Platelet Transfusion Practices during 2013 Dengue Epidemic of Delhi, India

“…In contrast to our study, Pallavi et al [9] noted higher percentages of dengue cases among children with the largest proportion in the age group of less than 10 years, while Ayyub et al [15] and Lye et al [16] noted preponderance in the age group of 20-40 years which was similar to our study. Male preponderance (Male-to-female ratio 2.4:1) in the present study was similar to that reported in other studies [17,18,19].…”

“…In the present study, the whole spectrum of dengue infections including DF (89.6%), DHF (6.4%) and DSS (4%) was seen. In a study by Pallavi et al [9], which included 71 serologically confirmed cases of dengue, who were given platelet transfusion, 65 patients (91.5%) had DF, 4 patients (5.6%) had features of DHF and 2 patients (2.9%) had signs and symptoms of DSS.…”

“…Thus, during explosive outbreaks of dengue when there is sudden surge in demands of platelet products, managing platelet inventory becomes a challenge especially when the transfusion facility also caters for oncology patients who are major consumers of the platelet products. Studies from different parts of India report high percentages of inappropriate transfusions ranging from 13.7-71% in dengue epidemics [9,10,11,12]. The present study was undertaken to assess and analyse the utilisation of platelet products in a tertiary care hospital during the 2013 dengue epidemic.…”

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

“…In contrast to our study, Pallavi et al reported that only 21 patients (6.12%) presented with haemorrhagic manifestations. 12 In 42 out of total 121 cases, patients though their platelet counts were 20,000/cu. mm and above, having not showed any bleeding manifestations or signs of sepsis, they were transfused with platelets.…”

“…The percentage of inappropriately transfused platelets in the studies conducted by Pallavi et al and Ahamed et al were found to be 36% and 56% respectively. 1, 12 Makroo also stated that many times the indications for prophylactic platelet transfusions were not according the guidelines as prescribed by WHO. Clinicians, because of intense social pressure and the so called dengue panic syndrome, demand for platelet transfusions though it is actually not needed.…”