Platelet transfusion in dengue should not be done without proper assessment

It is imperative to carry out proper diagnosis to confirm dengue in patients with a low platelet count

New Delhi, 09 August, 2017: Statistics indicate that India has recorded over 18,700 cases of dengue in 2017, thus far. Apart from other symptoms, dengue causes a drop in a person’s platelet count. However, as per international guidelines, unless the platelet count is below 10,000/or there is spontaneous active bleeding, no platelet transfusion is required in case of dengue patients. According to the IMA, the cause of death in dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multiorgan failure.

Many viral infections, which are not dangerous, can also lead to a drop in the platelet count. A proper diagnosis must be done to confirm whether it is dengue.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “At the first instance of plasma leakage from intravascular compartment to extra vascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual. The normal count of platelets is 1.5 lakh to 4.5 lakh per microlitre of blood. In dengue, this comes down to 20,000 or even lower, but reaches the normal once dengue is cured.”

It is estimated that dengue causes about 50 to 100 million infections per year worldwide. It is a viral disease transmitted by mosquitoes. There is no vaccine for the disease yet and the most effective protective measure is to avoid mosquito bites.

Adding further, Dr Aggarwal, said, “Family doctors should remember the ‘Formula of 20’ to understand the severity of dengue. Rise in pulse by 20,fall in upper blood pressure by 20 mmHg, pulse pressure lower than 20, hematocrit increase by 20%, platelet count less than 20,000, and more than 20 petechiae in the tourniquet test. Dengue takes on an epidemic form almost every year and creates panic among the public. It is a preventable disease and prevention is the first step in its management.”

Human beings are primarily responsible for the presence of Aedes aegypti in their environment through poor sanitation practices; improper solid-waste disposal practices; unsafe water storage practices and poor pool management. The government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. At an individual level, the following measures can be taken to prevent dengue.

• Avoid stagnation of water in and around the house to prevent mosquitoes from breeding.
• Close all containers that have water stored in them.
• Use mosquito screens, nets, meshes and insect repellent screens regularly.
• Do not venture out immediately after dusk. If you need to go out, make sure to wear full-sleeved clothing and apply a mosquito repellant cream.