Experts have reiterated that platelets transfusion has only a very limited role to play in the management of dengue fever and that panic reaction to dengue, with patients themselves demanding that they be transfused platelets is “unnecessary and dangerous.”
“Blood is a valuable drug, which is to be used with discretion for life-threatening situations as in the management of a serious road traffic accident case or for patients with critical illnesses such as blood cancer. Platelets are to be given for dengue management only when there are very clear indications – and such indications are very few. The general assumption among the public that platelets have to be transfused as soon as the count goes below one lakh is wrong,” says S. Ashwini Kumar, Professor of Medicine, Thiruvananthapuram Medical College.
The hype about platelets transfusion as the main mode of management for dengue has led to people scampering to secure platelets and blood banks running dry at major hospitals like the RCC. Many patients with critical illnesses in RCC, who actually require blood transfusions, are adversely affected by the dengue scare, doctors say.
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It might come as a surprise thus that the 160-odd page Guidelines for Dengue Management of the World Health Organisation has no mention about platelets transfusion.
It says that “Prophylactic platelet transfusions for severe thrombocytopaenia (lowered platelet count) in otherwise haemodynamically stable patients have not been shown to be effective and are not necessary.”
“The scare about dengue and platelet count among the public has been created by poorly read doctors and is unwarranted. The entire dengue management needs to be re-directed so that intravenous fluids and platelets are administered only judiciously. Platelets may need to be transfused if the count goes below 10,000 and even then only if there are any signs of bleeding,” a senior Health official says.
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WHO guidelines say that “most deaths from dengue occur in patients with profound shock, particularly if the situation is complicated by fluid overload.” Administration of IV fluids to a person with non-severe dengue and too much of fluids to one with severe dengue are poor practices, it says. The guidelines for dengue management brought out by the Health Department are adapted from the WHO guidelines. The focus is on continuous clinical assessment of the patient, symptom-wise and lab diagnosis-wise, so that doctors will know when the patient needs more intensive or hospital-based management.
Health officials say observation of general guidelines is necessary in an epidemic situation when too many patients crowd hospitals.
But individual management of patients is still the discretion of the doctor, who may need to deviate from the guidelines depending on his patient’s existing co-morbidities.