Platelet Transfusion Protocol in Dengue
Prophylactic platelet transfusion should NOT be routinely given to dengue patients with thrombocytopenia, as it does not prevent bleeding and may cause harm—reserve transfusion only for active significant bleeding or invasive procedures.
Key Evidence Against Prophylactic Transfusion
The strongest evidence comes from a 2017 multicenter randomized controlled trial that definitively showed prophylactic platelet transfusion in dengue patients with platelets ≤20,000/μL did not reduce clinical bleeding compared to supportive care alone (21% vs 26%, p=0.16), but significantly increased adverse events (13 events vs 2 events, p=0.0064), including serious complications like anaphylaxis, transfusion-related acute lung injury, and fluid overload 1.
Additional observational data reinforces potential harm: patients receiving prophylactic transfusion took longer to recover their platelet counts (3 days vs 2 days to reach ≥50,000/μL) and had longer hospitalizations (6 days vs 5 days) 2. Most concerning, patients with poor platelet recovery who received transfusion were more likely to bleed (OR 2.34) 3.
When to Transfuse in Dengue
Active Bleeding
- Target platelet count ≥50,000/mm³ for patients with active significant bleeding 4
- Transfuse to maintain this threshold until bleeding is controlled 4
- Minor bleeding manifestations alone (petechiae only) do NOT require transfusion 1
Invasive Procedures
- Major procedures/surgery: maintain 40,000-50,000/mm³ 4
- Lumbar puncture: transfuse if <50,000/mm³ 4
- Central venous catheter: transfuse if <20,000/mm³ 4
- Always obtain post-transfusion platelet count to confirm target achieved 4
High-Risk Situations Requiring Lower Threshold
Consider transfusion at platelet counts <20,000/mm³ ONLY if multiple additional risk factors present 4:
- Advanced age 4
- Uncontrolled hypertension 4
- Active peptic ulcer disease 4
- Concurrent anticoagulant use 4
- Recent trauma or surgery 4
Supportive Care Protocol (Standard Management)
For dengue patients with thrombocytopenia without bleeding, supportive care alone is appropriate 1:
- Bed rest and close monitoring
- Adequate fluid therapy
- Fever and pain management (avoid NSAIDs/aspirin)
- Serial platelet count monitoring
- Watch for warning signs of severe dengue
Common Pitfalls to Avoid
Do not transfuse based solely on platelet count thresholds. A restrictive strategy using low thresholds (even <5,000/μL without bleeding) has proven safe in dengue 5. The 2017 trial enrolled patients with platelets ≤20,000/μL and showed no benefit from prophylactic transfusion 1.
Recognize that dengue thrombocytopenia differs from malignancy-related thrombocytopenia. The guidelines for cancer patients (10,000/μL threshold for prophylaxis) 6 do not apply to dengue, where thrombocytopenia results from increased platelet destruction rather than impaired marrow production 6. Prophylactic transfusion is relatively contraindicated in conditions with increased platelet destruction 6.
Avoid transfusing patients presenting early in illness. Patients who present earlier with lower white cell counts are more likely to have poor platelet recovery 3, and transfusion in this group may paradoxically increase bleeding risk 3.
Transfusion Dosing When Indicated
When transfusion is necessary: