Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/connectdb.php on line 20

Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/DbSql.inc.php on line 13

Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/DbSql.inc.php on line 13
Indian Journal of Transfusion Medicine
  Indian Journal of Transfusion Medicine Indian Journal of Transfusion Medicine

Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/DbSql.inc.php on line 13

Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/DbSql.inc.php on line 13
image Image
Bottom Image
image Image
Journal Menu
Browse Journal
Current Articles
Last Articles
Archives
About the Journal
Bottom Image
Image SUBMIT YOUR ARTICLES Image
image Image
Important Links
Subscribe / Renew
Submit an Article
Submit Now!
Bottom Image
image Image
Newsletter Subscription

Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/DbSql.inc.php on line 13

Deprecated: mysql_connect(): The mysql extension is deprecated and will be removed in the future: use mysqli or PDO instead in /home/ijtm/public_html/includes/DbSql.inc.php on line 13
NAME
EMAIL
Unsubscribe
  
Bottom Image
 
image Image
Platelet Transfusion in Dengue Patients

Dr. Chhavi Gupta M.B.B.S,DCP(Pathology),PGDHA

Dr. Anshu Gupta     M.B.B.S, MD (Pathology)

 

Introduction
As we all know, Dengue fever is a major public health problem in India. Delhi is one of the big cities in India where dengue is endemic during monsoon season .The demand for platelets in the two forms Single Donor Platelet Concentrate (SDPC) and Random Donor Platelet Concentrate (RDPC) increases during this time.  Platelet transfusions are used to prevent spontaneous bleeding or to stop established bleeding in patients with a deficiency in platelet number or function.  Platelet transfusion is indicated prophylactically for patients who have platelet count less then or equal to 20000/ul to prevent bleeding. In Dengue patients, transfusion is done when platelet count is 10000-20000/ul and thrombocytopenic bleeding is present. All the patients of Dengue Shock syndrome require platelet support.

Dengue patients can be categorized into the four categories based on their platelet count:
1.    High risk
2.    Moderate risk
3.    Low risk
4.    No risk

High risk patient
The patients belonging to this group have platelet count <20,000/cumm and they are at high risk of bleeding. Such patients should be receiving prophylactic platelet transfusion. The patients in this category whose platelet count is less than 10,000/cumm have even a greater risk and need to be prioritized.

Moderate risk
All the patients whose platelet count is in between 21-40,000/cumm belong to moderate risk category. The patients of this risk group should be transfused with platelet only if they have any hemorrhagic symptoms.

Low risk
Those patients whose platelet count >40,000/cumm but <100,000/cumm for the age and sex should be observed and monitored carefully but should not receive unnecessary platelet transfusion because of the risk of transmission of blood borne infection (with no benefit of platelet transfusion).

No risk category
Patients falling in this category usually have the platelet count >100,000/cumm. They should never be transfused with platelet and should be managed on intravenous fluids and supportive therapy.

The two forms of Platelet Concentrate are:
Random Donor Platelet Concentrate (RDPC) is prepared from 450ml whole blood and separation of platelets is done within 6-8 hours after phlebotomy.  A unit of platelet concentrate prepared by this method contains at least 5.5X1010 platelets.  With the help of this method, the platelet count is elevated to 5000-10000/ul in an adult of approximately 70kg body weight and a single unit is adequate for transfusion to neonates or infants but for adults, 6-10 units are required for one therapeutic dose.  So the recipient is exposed to a large number of allogenic donors.

Single Donor Platelet Concentrate (SDPC) is prepared by the plateletpheresis procedure in which a portion of the donor's platelet and some plasma is removed and the Red Blood Cells, White Blood Cells and remaining plasma are returned back to the donor.  Also, the platelet component should be group specific or plasma compatible and should not contain clinically significant red cell antibodies.  A unit of platelet concentrate prepared by this method contains 3-7X1011 platelets and the platelet count is elevated to 30000-70000/ul in an adult of 70kg weight.  Single unit of platelets prepared by apheresis procedure have a platelet content similar to that of 6-8 units of pooled platelets or RDPCs.  In SDPC transfusion, recipient gets exposed to one donor per transfusion.

In the end we want to conclude the following:   
All hospitalized dengue patients can be categorized into the high, moderate, low and no risk patients based on their platelet count at the time of hospitalization. The high-risk patients should be given priority and the treating physician should take decision for platelet transfusion. Moderate risk patients should be observed carefully and platelet is transfused only if they have any hemorrhagic manifestations. Low risk patients should not be given platelet transfusion and should be managed on intravenous fluids and supportive therapy

RDPC
1.    Contains 5.5X1010 platelets.
2.    Plasma Volume is 50-60 ml.
3.    WBC Count is 108 in each unit.
4.    RBC Count is more.
5.    Increases Platelets Count from 5000-10000/ul.
6.    Exposes recipient to large number of donors.
7.    More exposure to infections.
8.    More risk of bacterial contamination.   

SDPC
1.    Contains 3-7X1011 platelets.
2.    Plasma Volume is 200 ml.
3.    WBC Count is less than 5.5X106 in each unit.
4.    RBCs are in traces.
5.    Increases Platelet Count from 30000-70000/ul.
6.    Exposes recipient to only one donor per transfusion.
7.    Less exposure to infections.
8.    Decreases risk of bacterial contamination and easy handling.

References
1.    Shivbalan S, Anandnathan K, Balasubramanian S, Datta M, Amalraj E. Predictors of spontaneous bleeding in Dengue. Indian J Pediatr 2004; 71:33-6. 

2.    Chairulfatah A, Setiabudi D, Agoes R, Colebunder R. Thrombocytopenia and platelet transfusions in dengue Haemorrhagic Fever and Dengue Shock Syndrome. WHO Dengue Bulletin 2003; 27:141-3. 
  
3. 
   World Health Organization: Guidelines for treatment of dengue Fever/dengue Haemorrhagic fever in small hospitals. Recognition of dengue Fever/dengue Haemorrhagic Fever (DF/DHF). Grading the severity of dengue infection 1999; 2-3, 5. 
   
4.    Pervin M, Tabassum S, Ali M, Mamun KZ, Islam N. Clinical and laboratory observations associated with the 2000 dengue outbreak in Dhaka, Bangladesh. Dengue Bulletin 2004; 28:99. 
   
5.    Epidemiological News Bulletin: Management of guidelines for dengue patients at Tan Tock Seng Hospital and communicable diseases center, Singapore. Platelet Transfusion 2005; 49.   
 
6.    Teik OC. A guide to DHF/DSS Management. Dengue Bulletin 2001; 25:48. 

7.    Directorate of Health Services. Management of Dengue Fever/DHF/DSS. Guidelines for indoor patients 2005; 4. 
   
8.    Kumar ND, Tomar V, Singh B, Kela K. Platelet transfusion practice during dengue fever epidemic. Indian J Pathol Microbiol 2000;43:55

9.    Transfusion Medicine Technical Manual by Dr R.K. Saran- 2nd edition 2003.

10.    Technical Manual- American Association of Blood Banks 16th edition.

Authors:
Dr. Chhavi Gupta M.B.B.S, DCP (Pathology), PGDHA, Senior Resident, Emergency Lab, IHBAS, Dilshad Garden, Delhi, Mobile: 9899207036, e mail id: Drchhavi_gupta@yahoo.com

Dr. Anshu Gupta M.B.B.S, MD (Pathology) ,Associate Professor, Department of Pathology, IHBAS, Dilshad Garden, Delhi , Mobile 9868396812, e mail id: dransh2002@yahoo.co.in

9158325_sca.php
Bottom Image
image Image
Dr. Chhavi Gupta
MBBS, PGDHA, DCP(PATHOLOGY)
View Full CV
Bottom Image
Image FOLLOW US RSS Feed Twitter Facebook in Image
Developed By LBM Infotech