Friday, 23 September 2016

Platelet transfusion is not the solution to the increasing incidence of dengue

Platelet transfusion is not the solution to the increasing incidence of dengue in the Capital

HCFI & IMA hold a webcast on the dangers of unnecessary platelet transfusion

New Delhi, September 22, 2016: Dengue cases are at an all-time high causing immense panic and chaos in the city. Every family member of patients diagnosed with dengue is found to be worrying about how to arrange the necessary platelets for transfusion.

“It is crucial that the public is educated about the fact that platelet transfusion is not the only solution and is not required in most of the dengue cases”, said Padma Shri Awardee Dr KK Aggarwal - President Heart Care Foundation of India (HCFI) & President Elect IMA at a webcast held today.

“What most people are not aware of is that most dengue cases are preventable and manageable. The risk of complications is less than 1% of dengue cases and if the public knows warning signals, all deaths from dengue can be avoided. One must however always remember it is a myth that all dengue patients require platelet transfusion,” he added.

Addressing the webcast, Dr NK Bhatia Medical Director Mission Jan Jagruti Blood Bank said, “Unnecessary transfusion causes more harm and puts the patient at risk of complications such as sepsis, transfusion-related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), alloimmunization and allergic and anaphylactic transfusion reactions. Transfusion must only be done if a person’s platelet count is less than 10,000, and he has active bleeding”.

It is also important to remember that platelet counts acquired by machine readings is not reliable, and a discrepancy of up to 40,000 can be found. Instead, the doctor must opt for a haematocrit test. Most dengue cases can be managed without testing by only measuring the difference between the upper and lower blood pressure. The pulse pressure should be kept over 40 mm Hg. The public must not pressurise the doctors to hospitalise patients whose illness can be managed at home. The beds should be made available for severe dengue patients instead.

The typical symptoms of dengue are fever, vomiting, headache, nausea, pain behind the eyes and severe joint and muscle pain.  Most dengue virus infections in adults are symptomatic  (86%) and in children under the age of 15 years are asymptomatic or minimally symptomaticClassic dengue fever is an acute febrile illness accompanied by a headache, retro-orbital pain, and marked muscle and joint pains. Symptoms typically develop between 4 and seven days after the bite of an infected mosquito. The incubation period may range from 3 to 14 days. Fever typically lasts for five to seven days.  The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults. Joint pain, body aches, and rash are more common in females.

Because a virus causes dengue fever, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgia lasts about one to two weeks.
In dengue, most complications occur within two days of the fever subsiding and most people are casual during this period. Dengue complications during this period are due to a shift of blood volume and patients require a rapid infusion of oral or intravenous fluids in large quantities during this time. 

Myths and facts about platelet transfusion
·      Right now there exists a platelet mania with the public demanding a platelet transfusion even when it is not required. People have a fear and they want to increase their platelet count either by unproved therapies or through transfusion. Both can cause more harm than good and awareness must be raised against this.
·      Platelet deficiency leads to thinning of blood, a condition that is not harmful as blood thinning is routine therapy for heart patients.
·      Risk of platelet shortage is when the blood becomes thick and that is a condition that needs to be managed by the treating doctor
·      Unnecessary transfusion may cause a resistance in the body and make a person’s platelets ineffective in a time of need, a situation called platelet refractoriness
·      Platelet transfusion is known to cause acute severe allergic reactions – a condition called anaphylaxis because of plasma proteins
·      Unnecessary transfusion can also cause platelet transfusion linked acute lung injury and confuse the doctor about whether lung involvement is due to platelets or dengue
·      When indicated, platelet transfusion (single donor) increases platelets by only 50,000 and they last in the body only for about 4-5 days
·      There are people whose baseline platelet counts may be permanently low and the panic may cause them to get an unnecessary platelet transfusion 

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