From the Research
Platelet transfusions in dengue fever should be restricted to patients with severe thrombocytopenia (platelet count below 10,000-20,000/μL) who have active bleeding or are at high risk for hemorrhage. This approach is supported by the most recent and highest quality study, which found that prophylactic platelet transfusion in adult dengue patients with platelet count <20,000/mm3 without bleeding did not reduce bleeding or expedite platelet recovery, and may even cause harm by slowing recovery of platelet count and increasing length of hospitalization 1.
Indications for Platelet Transfusion
The indications for platelet transfusion in dengue fever include:
- Severe thrombocytopenia (platelet count below 10,000-20,000/μL) with active bleeding or high risk for hemorrhage
- Significant bleeding with thrombocytopenia
- Urgent surgery or procedures with bleeding risk
- Platelet counts below 10,000/μL with additional risk factors for bleeding
Rationale for Conservative Approach
The rationale for this conservative approach is that most dengue-related thrombocytopenia is transient and self-limiting, with platelet counts typically recovering during the convalescent phase 2, 3. Additionally, platelet transfusions carry risks including transfusion reactions, fluid overload, and transmission of infections.
Clinical Considerations
Clinicians should focus on careful monitoring, maintaining adequate hydration, and treating underlying dengue infection rather than correcting laboratory values alone. The community and treating physicians should be educated regarding the judicious transfusion of platelets, and unnecessary and empirical use of platelets should be completely avoided, especially during an epidemic when there is scarcity in its availability 4.
Standard Dose and Transfusion Requirements
The standard dose is one unit of platelet concentrate per 10 kg body weight. Transfusion requirements should be assessed based on clinical parameters, such as bleeding manifestations and severity of thrombocytopenia, rather than solely on platelet count 5.