ArticlePDF Available

EFFECTIVENESS OF PLATELET TRANSFUSION IN DENGUE PATIENTS IN A TERTIARY CARE HOSPITAL

Authors:

Abstract

Objective: Dengue has been emerging as rapidly spreading and dreaded mosquito-borne disease caused by the bite of Aedes Aegypti Mosquito. Clinical features are variable and presents with Dengue fever or Dengue Hemorrhagic fever or more severe Dengue shock syndrome. Thrombocytopenia is presenting feature in all Dengue cases and some often presents with bleeding. Platelet transfusions are given in patients with haemorrhagic symptoms. 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 setup. Methods: The present study was conducted on 225 serologically confirmed dengue patients admitted at sawaimansign Hospitals between 1" of August to 30th of November 2022. Clinical data, reports of hematological investigation, platelets requirements and data obtained from SHealth services. 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 hemorrhagic 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 a 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.
EFFECTIVENESS OF PLATELET TRANSFUSION IN DENGUE PATIENTS IN A
TERTIARY CARE HOSPITAL
Original Article
VIJAY ANAND V.*, ANKIT SHARMA
Immunohematology and Blood Transfusion (IHBT), Sawai Mansingh Medical College, Jaipur, India
*Corresponding author: Vijay Anand V.; *Email: vijayanand1103@gmail.com
Received: 20 Apr 2023, Revised and Accepted: 11 Jun 2023
ABSTRACT
Objective: Dengue has been emerging as rapidly spreading and dreaded mosquito-borne disease caused by the bite of Aedes Aegypti Mosquito.
Clinical features are variable and presents with Dengue fever or Dengue Hemorrhagic fever or more severe Dengue shock syndrome.
Thrombocytopenia is presenting feature in all Dengue cases and some often presents with bleeding. Platelet transfusions are given in patients with
haemorrhagic symptoms. 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 setup.
Methods: The present study was conducted on 225 serologically confirmed dengue patients admitted at sawaimansign Hospitals between 1" of
August to 30th of November 2022. Clinical data, reports of hematological investigation, platelets requirements and data obtained from SHealth
services.
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 hemorrhagic
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 a 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.
Keywords: Platelet transfusion, Dengue
© 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2023v15i4.3022. Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr
INTRODUCTION
Dengue is the most rapidly spreading mosquito borne viral disease
in world and an estimated 50 million dengue infections occur
annually [1]. The south East Asian countries like India, Indonesia,
Myanmar and Thailand are at highest risk of Dengue
Fever/Dengue Haemorrhagic Fever. Dengue is viral disease caused
by dengue virus with four serotypes DEN-1 to DEN-4 of flavivirus
family transmitted through Aedes Aegypti mosquito [2]. A platelet
count of less than 100,000/μl is one of the diagnostic criteria for
dengue haemorrhagic fever [4]. However, severe
thrombocytopenia can be seen in both dengue fever and dengue
haemorrhagic fever. There is a significant negative correlation
between disease severity and platelet count [5]. Although low
platelet count and hypofibrinogenemia are the two most
prominent haemostatic defects responsible for bleeding in dengue
infection [6], thrombocytopenia and coagulation abnormalities do
not reliably predict bleeding in dengue infection [7, 8]. Causes of
thrombocytopenia include both bone marrow suppression and
platelet destruction. Immune complex-mediated platelet
destruction is probably the most important factor contributing to
thrombocytopenia in dengue infection.
The present study thus aims to study the effectiveness of platelet
transfusions in management of dengue patients with Dengue
haemorrhagic fever and Dengue shock syndromes and their
treatment outcome dengue patients with Dengue haemorrhagic
fever and Dengue shock syndromes and their treatment
outcome.
MATERIALS AND METHODS
This was a retrospective study conducted at SMS Medical college
hospital, Jaipur, on adult patients with dengue fever confirmed
positive by dengue serological Rapid test kits. The cases were
diagnosed and categorized as per WHO criteria into 1) Dengue fever
2) Dengue Haemorrhagic fever and 3) Dengue shock syndrome
based on severity of disease, bleeding manifestations, haematocrit
and thrombocytopenia. The age of patient, duration of fever before
admission, result of dengue serological test, haematocrit, platelet
count on admission during hospitalization, Presence of
haemorrhagic manifestation like petechiae, hematemesis, melena,
gum bleeding were recorded. DGHS guidelines for indication, dose
and monitoring of response for platelet transfusion were followed.
Blood samples were collected in EDTA anticoagulated vials, and platelet
counts were measured by automated count analyzer. In order to avoid
pseudo-thrombocytopenia, citrated samples were used to repeat platelet
counts if EDTA-induced platelet clumping was seen [13]. Platelet counts
were obtained at baseline (P0), 24 h (P24), and 72 h (P72) for all
patients. Additionally, platelet counts were also obtained within 10 min
to 1 h post transfusion (P1) for the treatment group (fig. 1).
Corrected count increment (CCI) was determined using the
following formula:
CCI = (PPI × BSA (m2)) × 1011/number of platelets transfused …. (1)
PPI represents the post-transfusion platelet increment (post-
transfusion platelet count minus pre-transfusion platelet count), and
International Journal of Current Pharmaceutical Research
ISSN- 0975-7066 Vol 15, Issue 4, 2023
V. A. V. & A. Sharma
Int J Curr Pharm Res, Vol 15, Issue 4, 40-42
41
BSA is the body surface area measured in square meters. We used
Mosteller formula for calculating BSA.
We measured PPI and CCI at 10 min to 1 h post-transfusion in the
treatment group. Based on their responsiveness to platelet
transfusion, patients in the treatment group were further divided
into responders and non-responders. Patients with PPI*10,000/μl
and/or CCI*5,000/μl 1 h post-transfusion were considered
responders; the rest were considered. s. Patients having platelet
count>20,000 per µl. in the absence of bleeding manifestations were
considered to have received inappropriate platelet transfusion.
RESULTS
Of the 242 clinically suspected dengue patients, 225 were positive
for anti-dengue IgM antibodies. Among the of 225 serologically
positive dengue cases, 199 (88.4%), 21 (9.3%) od 5 (2.2%) were
classified as DF, DHF and DSS, respectively accolg to WHO
classification. The involvement of all age groups, especially an adult
predominance, was observed. The mean age of the dengue patient
was 27 y and the most belonged to the 21-30 y age group, which
included 73 patients (32.44%), [fig. 1]. Platelet count
of<100,000/cumm was detected in 191 (84.88%) patients and
haematocrit value of>45% was observed in 32 patients (14.22%) at
the time of admission. Hemorrhagic manifestations were present in
34 (15.11%) patients of dengue infection, which mainly included
petechiae-21 (9.3%) patients, epistaxis-6 (2.7%) patients,
haematemesis-5 (2.22%) patients, melaena-3 (1.33%) patients, gum
bleeding-8 (3.55%) patients. Bleeding occurred more often in
patients with severe thrombocytopenia and was frequent when the
platelet count was below 20,000/cumm [table 1]. About 96 among
the 225 serologically confirmed patients (42.60%) received platelet
transfusion therapy. Among them 58 patients were male and 38
patients were female. About 79 (39.69%) of the 199 patients with
dengue fever required platelet transfusion. Similarly among the 21
DHF patients, 15 (71.42%) patients and out of 5 DSS patients only 2
(40%) patients required platelet transfusion.
All the 10 patients having platelet count<10,000/cumm had received
platelet transfusion. Out of 40 patients having platelet count in
between 11-20,000/cumm, 37 patients received platelet transfusion
whereas 43 patients out of 77 had received platelet transfusion that
were having the platelet count in the range of 21-40,000/cumm. 6
patients having platelet count in the range of 41-100,000/cumm
received platelet transfusion. None of the 19 (8.4%) patients having
platelet count>100,000/cumm, received platelet transfusion. Out of
49 patients having platelet count>20,000/cumm, and receiving
platelet transfusion, 18 patients had haemorrhagic manifestations
while 31 patients had no haemorrhagic manifestations.
Most of the patients receiving platelet transfusion recovered
completely and were discharged within 2-5 d of their last platelet
transfusion. The platelet count had picked up considerably and the
average platelet count of the patients at discharge who received
platelet transfusion were 95,000/cumm.
Besides platelet transfusion, FFP and PRC were also transfused to the
dengue patients. Out of 12 patients who were transfused with FFP, seven
had abnormal PT/PTT, INR and four patients were transfused with FFPs
along with platelet transfusion. Five dengue patients had received PRC
transfusion whose hemoglobin level was<8.0 gm/dl.
During the study period there were 50 patients whose platelet count
was<20,000/cumm. Out of these, 47 were given platelet transfusions
and there were three patients with a platelet count between
15,000/cumm and 20,000 who did not bleed and improved without
any transfusion.
There was one patient who was suffering from falciparum malaria
along with dengue fever. Only two patients died during
hospitalization (mortality being 0.88%). One had additional clinical
manifestations like septicaemia, while the other had severe bleeding
with multi-organ failure and both belonged to 31-40 y age group.
DISCUSSION
Dengue fever is a major public health problem in India. This study
showed that the majority of dengue cases were adult with the largest
proportion in the age group of 21-30 y. This is in accordance with
the findings of Pervin et al. Thrombocytopenia was found in 84.88%
of the confirmed cases on admission. This prevalence is comparable
with the findings of Chairulfatah et al. who found a similar incidence
of 83% in hospitalized dengue patients. Bleeding occur significantly
more often in patients with severe thrombocytopenia most often in
patients with a platelet count less than 20,000/cumm which is
similar to the finding of Shivbalan et al. but Chairulfatah et a l. found
significant bleeding in patients with thrombocyte count less than
15,000/cumm. Bleeding during DHF may result from a combination
of factors such as thrombocytopenia, coagulation defects and
vasculopathy [2]. Therefore before platelet transfusion coagulation
profile should be done to rule out the cause of bleeding.
The DHS guidelines stipulate that platelet transfusion should be
given to patients with platelet count<20,000/cumm. In our study, 47
of the 97 patients receiving platelet transfusion followed the norms
laid down by DHS for the hospitalized dengue patients. 49 patients
had a platelet count greater than 20,000/cumm, 18 out of whom had
hemorrhagic manifestations like petechiae, gum bleeding, epistaxis,
etc. that necessitated the use of platelet transfusion. However, 31
(13.77%) patients received inappropriate platelet transfusion.
Kumar et al. had found 56.2% of inappropriate platelet transfusion
during dengue epidemics in Delhi during 1999. Many times the
prescription for this blood component are not based on medical
rationale, but as a response to an intense social pressure on the
treating physicians by the patients and their relatives
All the patients of DSS required platelet support. Two patients in age
group of 31-40 y were not given platelets as they died soon after
admission. None of the DHF patients<20 y required platelets. The
transfusion of platelets in DF was more in patients above the age of
11 than below 11 y as the possibility of repeat infections was higher.
Dengue patients can be categorized into the four categories based on
their platelet count at the time of admission:
1. High risk
2. Moderate risk
3. Low risk
4. No risk
High risk patient
The patients belonging to this group have platelet count
<20,000/cumm and they are at high risk of bleeding. Such patients
by the rule of the thumb should be receiving prophylactic platelet
transfusion. The patients in this category whose platelet count is less
than 10,000/cumm have even a greater risk and need to be
prioritized in case of an epidemic or, in case of limited resources.
Moderate risk
All the patients whose platelet count is in between 21-40,000/cumm
belong to moderate risk category. The patients of this risk group
should be transfused with platelet only if they have any
haemorrhagic symptoms.
Low risk
Those patients whose platelet count>40,000/cumm
but<100,000/cumm for the age and sex should be observed and
monitored carefully but should not receive unnecessary platelet
transfusion because of the risk of transmission of blood borne
infection (with no benefit of platelet transfusion).
No risk category
Patients falling in this category usually have the platelet
count>100,000/cumm. They should never be transfused with
platelet and should be managed on intravenous fluids and
supportive therapy.
CONCLUSION
All hospitalized dengue patients can be categorized into the high,
moderate, low and no risk patients based on their platelet count at
V. A. V. & A. Sharma
Int J Curr Pharm Res, Vol 15, Issue 4, 40-42
42
the time of hospitalization. The high-risk patients should be given
priority and the treating physician should take decision for platelet
transfusion. Moderate risk patients should be observed carefully and
platelet is transfused only if they have any haemorrhagic
manifestations. Low risk patients should not be given platelet
transfusion and should be managed on intravenous fluids and
supportive therapy.
FUNDING
Nil
AUTHORS CONTRIBUTIONS
All the authors have contributed equally.
CONFLICT OF INTERESTS
Declared none
REFERENCES
1. Shivbalan S, Anandnathan K, Balasubramanian S, Datta M,
Amalraj E. Predictors of spontaneous bleeding in Dengue.
Indian J Pediatr. 2004;71(1):33-6. doi: 10.1007/BF02725653,
PMID 14979383.
2. Chairulfatah A, Setiabudi D, Agoes R, Colebunder R.
Thrombocytopenia and platelet transfusions in dengue
haemorrhagic fever and dengue shock syndrome. WHO Dengue
Bulletin. 2003;27:141-3.
3. World Health Organization. Guidelines for treatment of dengue
fever/dengue haemorrhagic fever in small hospitals.
Recognition of dengue fever/dengue haemorrhagic fever
(DF/DHF). Grading Severity Dengue Infect. 1999;2-3:5.
4. Pervin M, Tabassum S, Ali M, Mamun KZ, Islam N. Clinical and
laboratory observations associated with the 2000 dengue
outbreak in Dhaka, Bangladesh. Dengue Bull. 2004;28:99.
5. Epidemiological News Bulletin: management of guidelines for
dengue patients at Tan Tock Seng Hospital and communicable
diseases center, Singapore. Platelet Transfus. 2005;49.
6. Teik OC. A guide to DHF/DSS management. Dengue Bull.
2001;25:48.
7. Anuradha S, Singh NP, Rizvi SN, Agarwal SK, Gur R, Mathur MD.
The 1996 outbreak of dengue hemorrhagic fever in Delhi, India.
Southeast Asian J Trop Med Public Health. 1998;29(3):503-6.
PMID 10437946.
8. Transfusion medicine [technical manual]. DGHS. 2nd ed; 2003.
9. Kansay S, Singh H. Effect of introduction of single-donor apheresis
platelets in dengue management: a comparative analysis of two
consecutive dengue epidemics. J Lab Physicians. 2018;10(2):173-8.
doi: 10.4103/JLP.JLP_10_17, PMID 29692583.
10. Charulfatah A, Setiabudi O, Agoes R, Colebundi R.
Thrombocytopenia and platelet transfusion in dengue
hemorrhagic fever and dengue shock syndrome. WHO Deng
Bull. 2003;27:141-3.
11. Lum LCS, Abdel Latif MEA, Goh AYT, Chan PWE, Lam SK.
Preventive transfusion in dengue shock syndrome-is it
necessary? J Pediatr. 2003;143(5):682-4. doi: 10.1067/s0022-
3476(03)00503-1, PMID 14615749.
12. Narayanan M, Aravind MA, Thilothammal N, Prema R,
Sargunam CS, Ramamurty N. Dengue fever epidemic in
Chennaia study of clinical profile and outcome. Indian Pediatr.
2002;39(11):1027-33. PMID 12466573.
13. Machakanur DV, Savitha DM, Krishnamurthy DB. Platelet
transfusion in dengue: peril or protection. Int J Med Res Rev.
2015;3(3):303-7. doi: 10.17511/ijmrr.2015.i3.056.
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
BACKGROUND The frequency of dengue outbreak is increasing in Southeast Asian countries these days and since there are no specific drugs against the dengue virus; therefore, treatment consists of mainly symptomatic and supportive care. AIMS Platelet transfusion forms one of the major parts of treatment therapy in dengue; therefore, this study was initiated to elicit the effect of introduction of single-donor apheresis platelets (SDAPs) in dengue management. SETTINGS AND DESIGN This is a retrospective study conducted on 622 clinically suspected cases of dengue infection who received platelet transfusions between August 2013 and December 2015 in a teaching hospital of North India. MATERIALS AND METHODS Clinical data, reports of hematological investigation, transfusion request forms, platelet requirements, and data obtained from daily follow-up and blood bank records were analyzed using IBM SPSS version 20. RESULTS Average platelet count at which platelet transfusion initiated was 25,703/cumm. Average number of random donor platelets (RDPs) transfused significantly decreased in 2015 (2013 vs. 2015 is 5.4 vs. 4.3) due to the transfusion of SDAP to patients with very low platelet count and those with superimposed high-risk factors. Mean length of stay in hospital was similar for patients receiving RDP only and for those receiving RDP and SDAP both (5.48 vs. 5.54) while that for patients receiving SDAP only was quite lower (3.6). Overall cost of stay was higher for those receiving SDAP transfusions. CONCLUSION Decision for initiating platelet transfusions and calculating its dose for dengue patients is highly variable, but transfusing high-dose platelets such as SDAP at an appropriate stage can reduce further requirement of platelet transfusions, fasten the recovery, reduce the hospital stay, lower the risk of transfusion-associated adverse reactions, and can further minimize the associated morbidity and mortality.
Article
Full-text available
The presence of thrombocytopenia was determined in 1,300 patients with dengue haemorrhagic fever (DHF) (1,198; 92%) and dengue shock syndrome (DSS) (102; 8%) admitted to four major hospitals in Bandung, Indonesia. A dengue serological test was performed on 1,100 (85%) of the patients with a positive result in 763 (69%), HI test on 243 patients (22%), IgG dengue blot on 489 patients (44%) and IgM dengue blot on 25 patients (2.3%). Since an accurate diagnosis was found only in a small proportion of the cases (positive HI test), all the clinically-diagnosed DHF/DSS cases were analysed. Thrombocyte count of less than 100,000/μl was present in 445 (34%) cases on admission and in 637 (49%) cases during hospitalization. In the serologically-confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/μl) was 58% on admission and 83% during hospitalization. Severe bleeding was recorded in 76 (6%) of all DHF/DSS cases and occurred more often in patients with severe thrombocytopenia. O ne hundred and fifty-six (12%) DHF/DSS cases received a platelet transfusion; among them only 30 (19%) had a platelet count below 25,000/μl. No difference in the frequency of bleeding was observed comparing patients who received or those who did not receive a platelet transfusion (even in those with a platelet count < 25,000/μl). In conclusion, a large number of patients with DHF/DSS in Bandung hospitals receive platelet transfusions, even if thrombocyte counts are above 25,000/μl. This study suggests that in most DHF/DSS cases, platelet transfusions do not influence the incidence of severe bleeding. Treatment costs for DHF/DSS cases could be reduced if these unnecessary platelet transfusions are avoided. Further studies undertaken only in accurately confirmed cases are needed to clarify this finding.
Article
Full-text available
A major outbreak of dengue hemorrhagic fever (DHF) affected more than 10,000 people in Delhi and neighboring areas in 1996. The outbreak started in September, peaked in October to November and lasted till early December. The clinical and laboratory data of 515 adult patients admitted to Lok Nayak Hospital, New Delhi were reviewed. Fever (100%), myalgias and malaise (96%), abdominal pain (10.2%) and vomiting (8.7%) were the prominent presenting features. Hemorrhagic manifestations were seen in all patients- a positive tourniquet test (21.2%), scattered petechial rash (23.07%), confluent rash (2.7%), epistaxis (38.4%), gum bleeds (28.06%) and hematemesis (22.86%) being the major bleeding manifestations. Hepatomegaly was observed in 96% of the patients. Laboratory investigations revealed thrombocytopenia, hemoconcentration and leukopenia. Serological confirmation with a microcapture ELISA technic was done in 143/515 patients. The mortality rate was 6.6% and, multiple bleeding manifestations, severe thrombocytopenia, hypoproteinemia and dengue shock syndrome (DSS) were associated with a higher mortality.
Article
Full-text available
We compared 53 patients with Dengue shock syndrome (DSS) who received preventive transfusions with 53 who did not. Significant differences in the development of pulmonary edema and length of hospitalization (P<.05) and none in hemorrhage (P=.136) were observed. Preventive transfusions did not produce sustained improvements in the coagulation status in DSS.
Article
Introduction: Dengue is a common vector-borne disease in developing-countries with significant morbidity & mortality. Thrombocytopenia is being a common complication in dengue needs clear guidelines for management. Role of Platelet transfusion in this condition is bit controversial. Method: It was an observational, analytical case-control study based on case record review of children with Dengue with thrombocytopenia(less than 100000/cu mm) with or without minor bleeding, admitted to Cheluvamba Hospital of Mysore Medical College & Research Institute, Mysore, India throughout epidemic period of 2013(June-August). Total of 138 dengue-positive children were studied with respect to two distinct groups with objective to compare the clinical-outcome and platelet-recovery between dengue-positive children with platelet-transfusion (cases) and those without platelet-transfusion (controls). Cases and controls were analyzed for various parameters through SPSS for windows (version 20.0). P-value of < 0.05 was taken as statistically significant. Results: Present study included 36 cases and 102 controls whose baseline-parameters were comparable. ARDS was more common in cases than controls (p=0.000). Duration of platelet recovery, time taken to become afebrile and hospitalization were prolonged in cases as compared with the controls and were statistically highly significant (p=0.000). Another analysis in 11000 to 30000/cu mm platelet count groups revealed the similar results of prolonged duration of platelet recovery, time taken to become afebrile and duration of hospitalization amongs cases as compared with controls. Conclusion: There is no advantage of platelet-transfusion in dengue-positive children with thrombocytopenia with or without minor bleeds. Platelet-transfusion prolongs the duration of platelet-recovery, time taken to become afebrile and hospitalization.
Article
A guide to the medical management of dengue for reducing its case-fatality rate as experienced in Singapore is furnished. The mortality from dengue in Singapore is low and most cases recover uneventfully. However, complacecy and under-estimation of the disease does occur. It is important to recognize the symptoms of severity and understand the patho-physiology that leads to dengue shock syndrome (DSS). A protocol giving indications of platelet transfusion will guide appropriate usage. Patients should be informed prior to platelet transfusion as to its possible dangers. In our experience, with good initial appropriate support in a stable patient, platelet trasfusion is seldom needed till the platelets fall below 10,000/mm3. DSS is reversible if appropriately treated with fluids and plasma infusion to reverse the osmotic permeability gradient due to hypoalbumenaemia. Severe pulmonary oedema causes adult respiratory distresss syndrome (ARDS). The lung effusions and hypotension must be differentiated from other causes of shock and pulmonary oedema. Correction of acid-base balance and internal bleeding if present, recognition and appropriate treatment of septicaemia and pneumonia, and avoiding fluid overload usually result in recovery. Nosocomial and mycoplasma pneumonias, not uncommonly, complicate severe ARDS. Fatalities are often these recognized infections.
Article
A large outbreak of dengue fever (DF)/dengue haemorrhagic fever (DHF) occurred in Dhaka city, Bangladesh, in 2000. The present study was conducted on 105 clinically-suspected cases of DF to confirm the diagnosis, determine the major clinical manifestations and correlate the haemorrhagic manifestations with different dengue serotypes circulating during the outbreak. A total of 97 cases were positive for anti-dengue IgM and were considered as recent dengue infection; 52.6% patients had secondary and 47.4% had primary dengue infection. According to WHO case-definition, 79 cases were classified as DF, 17 as DHF and 1 as DSS. Among the 18 DHF/DSS cases, 14 had secondary and 4 had primary type of antibody response. The mean age of the dengue patients was 29.2±12.9 years and most of them (37.1%) belonged to the 20-29-year age group. All the clinically-suspected patients had fever ranging from 100-104 ºF, but the secondary dengue fever patients had higher (101.6±1.4 ºF) mean body temperature. Common complaints included myalgia (84.5%), headache (82.5%), arthralgia (68.0%), lethargy (80.4%) and retro-orbital pain (49.5%). Rash, especially maculopapular type, was significantly higher in primary infection (P
Article
Children with dengue fever presenting to the Institute of Social Pediatrics, Government Stanley Hospital, during the months of October to December 2001, were prospectively followed up for clinical profile and outcome. Commonest clinical features were fever, vomiting, bleeding, body pain and hepatomegaly. Elevated liver enzymes and low platelet counts were common laboratory findings in dengue. Hepatomegaly, positive tourniquet test, elevated haematocrit and thrombocytopenia were more common in DHF and DSS group. Retro-orbital pain was slightly more in DHF and DSS groups and there was a tendency for DSS to present at an earlier age. There was no correlation between platelet counts and bleeding in classical dengue cases.
Article
To identify the predictive factors for spontaneous bleeding manifestations in Dengue illness in infants and children. 60 cases of Dengue viral infection with spontaneous skin and or mucosal bleed were compared with 72 cases without spontaneous bleed. The protean bleeding manifestations in dengue infection were recorded. Various clinical and laboratory parameters were analyzed using univariate and logistic regression analysis. Prothombin time was abnormal only in cases with spontancous bleed. A combination of (a) biphasic pattern of fever, (b) hemoconcentration, (c) platelet count less than 50,000/mm3 and (d) elevated ALT had a sensitivity of 79.2%, specificity of 64.7% with a positive predictive value of 70% and a negative predictive value of 75% in predicting spontaneous bleeding in dengue.
Thrombocytopenia and platelet transfusion in dengue hemorrhagic fever and dengue shock syndrome
  • A Charulfatah
  • O Setiabudi
  • R Agoes
  • R Colebundi
Charulfatah A, Setiabudi O, Agoes R, Colebundi R. Thrombocytopenia and platelet transfusion in dengue hemorrhagic fever and dengue shock syndrome. WHO Deng Bull. 2003;27:141-3.