There are no established current guidelines for strategising platelet transfusion in dengue fever patients. However, review of literature, and our experience with these patients over last one decade supports following recommendations:
- No prophylactic platelet transfusion is significant to bleeding. Significant bleeding should mean reduction of hematrocrit.
- Patient should be closely observed if platelet count falls below 20,000/cumm and platelet should be transfused only if there is significant bleeding; simple petechial haemorrhages may not be indication for platelet transfusion.
- In dengue fever, bleeding may occur with platelet count >50,000 and there may not be any bleeding even at <5000/cmm. So there may be no direct correlation between bleeding and platelet count in certain cases. Intracranial haemorrhage and contemplated surgical procedure may be indications for maintaining platelet count>50,000/cmm.
- Current evidence suggests that platelet transfusion should be preceded by FFP or cryoprecipitate infusion in bleeding cases (even plasma heresies may be indicated). Unwarranted prophylactic platelets should be given rather than random donor platelets concentrates. One SDP is usually equal to 6 units of RDPs. The lifespan of transfused platelets is approx 5 days. Repeated platelet transfusion should be avoided.
- Platelet count by automatic counting machines counts clumps as one unit, therefore, making decisions on the basis of auto counted platelets may be tricky. Clinicians are better advised to use manually counted platelet for making decisions of platelet transfusion. Platelets should be transfused immedediately after delivery from the blood bank. Delay may lead to platelet destruction.
At Rajasthan Hospital, Jaipur, we ensure that treatments are followed through protocols which are created and regularly updated through cumulative learning and experiences. Our team of senior doctors and specialists ensure that the patient outcome is always positive while ensuring that no excess of anything is done.