Firdaus Khan
Thrombocytopenia or low platelet count is common in dengue and there is concern about risk of bleeding. Many studies and our own experience now have shown no benefit from prophylactic platelet transfusion in adult dengue patients, said Dr. KK Aggarwal, President, Heart Care Foundation of India.
Findings from a retrospective paediatric intensive care study presented by Dr Lye D.C and group at the 18th European Congress of Clinical Microbiology and Infectious Diseases at Barcelona, Spain show no benefit in prophylactic platelet transfusion for thrombocytopenia <30,000/uL.
In the study all dengue patients admitted were retrospectively reviewed. Patients without bleeding when their platelet count dropped <20,000/uL were evaluated. Prophylactic platelet transfusion was defined as platelet transfusion without clinical bleeding excluding petechiae (skin bleeding).
Baseline data on admission and clinical data when patients platelet count first dropped <20,000/uL were compared. Outcome measures included: any bleeding after platelet transfusion, median platelet increase the next day, median time to platelet count 50,000/uL, median length of hospital stay, and death.
Of 1973 laboratory-confirmed dengue patients, 256 developed thrombocytopenia <20,000/uL without bleeding, of whom 188 were given prophylactic platelet transfusion. Baseline demographic, clinical and laboratory features at that platelet threshold were similar, except that transfused patients were significantly more likely to be febrile (33% vs. 18%).
Median platelet count on day of platelet transfusion was 15,000/uL in transfused vs. 16,000/uL in non-transfused patients. Bleeding occurred subsequently in 1 of 188 transfused (0.5%) and 2 of 68 non-transfused (3%) (p = 0.17).
Median platelet increase the next day was 6000/uL vs. 13,000/uL, and median time to platelet 50,000/uL was 3 days vs. 2 days, in transfused vs. non-transfused patients respectively. There was no difference in length of stay and death.
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