From the Guidelines
A platelet count of 16,000 in dengue fever typically requires platelet transfusion to reduce the risk of spontaneous bleeding. In dengue patients, the decision to transfuse platelets is critical and should be based on the most recent and highest quality evidence available. According to the AABB guidelines 1, prophylactic platelet transfusion is recommended for patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding. Although this specific guideline is for hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia, the principle of preventing bleeding in thrombocytopenic patients can be applied to dengue fever patients with severe thrombocytopenia. Some key points to consider in the management of thrombocytopenia in dengue fever include:
- The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding 1.
- The typical dose for platelet transfusion is up to a single apheresis unit or equivalent, as greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective 1.
- The decision to transfuse should consider other clinical factors such as bleeding manifestations, hemodynamic stability, and the phase of dengue illness.
- Platelet transfusions help prevent serious hemorrhagic complications while the patient's immune system recovers from the viral infection. Given the patient's platelet count of 16,000, which is close to the threshold of 20 × 10^9 cells/L suggested for prophylactic platelet transfusion in certain clinical scenarios by the AABB 1, and considering the potential for bleeding in dengue fever, platelet transfusion is recommended to prevent spontaneous bleeding and improve patient outcomes.
From the Research
Platelet Transfusion in Dengue Fever
- The decision to transfuse platelets in dengue fever patients with thrombocytopenia is complex and depends on various factors, including the severity of thrombocytopenia and the presence of bleeding manifestations 2, 3, 4, 5.
- A platelet count of 16,000 is considered severe thrombocytopenia, but the evidence suggests that prophylactic platelet transfusion may not be necessary in the absence of bleeding manifestations 4, 5.
- Studies have shown that prophylactic platelet transfusion in adult dengue patients with platelet count <20,000/mm3 without bleeding does not reduce clinical bleeding and may even slow down platelet recovery 4.
- The use of single-donor apheresis platelets (SDAPs) in dengue management has been shown to reduce the requirement for further platelet transfusions, fasten recovery, and lower the risk of transfusion-associated adverse reactions 6.
- However, the decision to initiate platelet transfusions and calculate its dose for dengue patients is highly variable, and more research is needed to standardize the guidelines for platelet transfusion in dengue fever 3, 6.
Indications for Platelet Transfusion
- The presence of bleeding manifestations, such as petechiae, gum bleeding, or epistaxis, is a clear indication for platelet transfusion 3, 4.
- Severe thrombocytopenia (platelet count <20,000/mm3) with or without bleeding manifestations may require platelet transfusion, but the decision should be made on a case-by-case basis 2, 4, 5.
- The use of platelet transfusion in dengue fever patients with thrombocytopenia should be guided by clinical judgment and evidence-based guidelines, rather than routine prophylactic transfusion 5.