'Platelet transfusion could be deferred in dengue patients'

Platelet transfusion may not be needed or deferred for patients suffering from severe dengue if the percentage of young regenerated platelets in the blood is above or equal to a cut-off mark, a first of its kind clinical study has claimed.
The study was conducted by the Sir Ganga Ram Hospital here on 50 adult dengue patients having a platelet count of less than 100000/cu mm, who were admitted there last year.
Platelet is one of the major components of blood that is affected by dengue and its normal value is between 1.5 to 4.5 lakh.
"In this study, the relationship of reduced platelet count with immature platelet fraction (IPF) was evaluated on a daily basis. IPF refers to percentage of young regenerated platelets in the peripheral blood.

"On the basis of observing 100 normal individuals, we had earlier found out that the range of normal IPF was 0-7.25 per cent. So, if the IPF is more than 7.25 per cent, it signals presence of younger regenerating platelets and once it crosses 10 per cent mark, it signals that decreased platelet count will increase in next the few hours," said Dr Jyoti Kotwal, Chairman, Department of Haematology at the hospital.
Immature platelets are young platelets recently released from bone marrow of dengue patients. IPF is an important parameter to predict platelet recovery, she said.

According to the report released today, out of the 50 patients studied, 40 had dengue without alarm signs, nine had the disease with alarm signs and one was classified as having severe dengue, the hospital said.

Decreased platelet count in dengue patients may lead to bleeding. In the study, bleeding was reported in 9 out of the 50 patients, it said.
"According to existing guidelines, platelet transfusion is indicated when its count is less than 20000/cumm or if the patient has bleeding.
"In our study, the indications of transfusion were present in 18 patients. However only 12 patients out of 18 received appropriate transfusion, while in the rest cases platelet transfusion was deferred as their IPF values were high," Kotwal said.
"So, if the patient had a platelet count of 18,000 and the IPF was above 10 per cent, we first deferred the transfusion and realised it regenerated later, so we didn't do it. And, in case of a patient with 12,000 count, if the IPF was 3.5-4 per cent, we carried the transfusion later as we realised the count was still dropping after deferring it," she said.

Death in dengue patients can occur either due to haemorraghic fever or dengue shock syndrome, which happens in severe cases.
Nine dengue deaths have been reported in Delhi this season, while the total number of cases has gone up to over 770.
Department of Internal Medicine & Department of Haematology at the Sir Ganga Ram Hospital is using IPF to monitor platelets in dengue patients during the current season also, it said.