What is the course of action for a dengue patient with a platelet count of 60,000, experiencing stomach tightness, but no other warning signs, on the 3rd day of hospital admission and 1 week after diagnosis?

Management of Dengue Patient with Platelet Count of 60,000 and Stomach Tightness

For a dengue patient on day 7 of illness with platelet count of 60,000 and stomach tightness but no other warning signs, close monitoring without platelet transfusion is recommended, as platelets typically begin to recover after day 6 and prophylactic platelet transfusion has not been shown to reduce bleeding risk.

Assessment of Current Status

• The patient is currently on day 7 of dengue illness (1 week since diagnosis) and day 3 of hospitalization 1
• Current platelet count is 60,000/mm³, which has decreased from 100,000/mm³ at diagnosis 2
• The patient reports stomach tightness but has no tenderness on palpation 1
• No other warning signs are present 1, 3

Interpretation of Clinical Picture

• The patient is likely entering the recovery phase of dengue, as platelet counts typically begin to recover after day 6-7 of illness 2
• Stomach tightness without tenderness could indicate mild plasma leakage, which should be investigated with ultrasound to rule out ascites 1, 3
• The absence of other warning signs (persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, liver enlargement) is reassuring 3

Recommended Course of Action

1. Continue close monitoring without platelet transfusion

   • Prophylactic platelet transfusion is not recommended as it does not reduce bleeding risk and may potentially delay platelet recovery 4
   • Monitor platelet count daily until showing clear upward trend 2

2. Proceed with abdominal ultrasound

   • Ultrasound is the most sensitive technique to detect plasma leakage and ascites 5
   • This will help determine if the stomach tightness is related to fluid accumulation 5

3. Monitor for warning signs

   • Check for development of any warning signs: persistent vomiting, abdominal pain/tenderness, clinical fluid accumulation, mucosal bleeding, lethargy, liver enlargement, or increasing hematocrit with decreasing platelets 1, 3

4. Supportive care

   • Maintain adequate oral hydration 1
   • Avoid NSAIDs and use acetaminophen/paracetamol for fever or pain 1
   • Monitor vital signs every 4-6 hours 1

5. Laboratory monitoring

   • Daily complete blood count to track platelet recovery 2
   • Consider liver function tests (AST, ALT) and albumin levels as these can be prognostic indicators for severe dengue 2

Expected Clinical Course

• Platelet count should begin to rise within the next 24-48 hours as the patient is now in day 7 of illness 2
• If ultrasound shows no significant fluid accumulation and platelet count begins to increase, the patient can likely be discharged within 1-2 days 1
• If platelets continue to drop or other warning signs develop, more intensive monitoring and management will be required 1, 3

Cautions and Pitfalls

• Avoid prophylactic platelet transfusion based solely on platelet count, as this practice has not been shown to reduce bleeding risk and may delay platelet recovery 4
• Do not discharge the patient until platelet count shows a clear upward trend and there are no warning signs 3
• Be vigilant for late complications of dengue, which can still occur during the recovery phase 2
• Ensure adequate hydration while avoiding fluid overload 1