Preventive platelet use for dengue of little help

Blood banks in Bengaluru have been seeing a steep platelet demand for dengue patients this month, but research has shown that platelet transfusion as a preventive measure doesn't help, and may even harm the patient.

Some institutions like St John's Medical College have completely stopped prophylactic (preventive) platelet transfusion, while many still transfuse platelets based on the patient's low platelet count.

Many hospitals stick to the National Guidelines for Clinical Management of Dengue Fever, 2014. It says that prophylactic transfusion can be done when platelet count is below 10,000 per microlitre, even when the patient has no signs of bleeding.

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However, WHO and CDC guidelines do not recommend prophylactic transfusion, saying it is not beneficial and could lead to fluid overload. "With unnecessary transfusions, patients face the risk of developing allergic reactions, and also the risk of infections as platelets are stored at room temperature," Dr Sowmya Umesh, associate professor of medicine at St John's, says.

"Patients with counts as low as 4,000 can be managed without transfusion if they are stable. But many are transfused at 20,000 count or more."

A commonly cited study is a Singapore-based one on 788 dengue patients with platelet count lower than 20,000 and no bleeding, published in 2016. The finding was that those who got platelets had no advantage over those who didn't.