Thrombocytopenia and platelet transfusions in dengue haemorrhagic fever and dengue shock syndrome

Abstract

The presence of thrombocytopenia was determined in 1,300 patients with dengue haemorrhagic fever (DHF) (1,198; 92%) and dengue shock syndrome (DSS) (102; 8%) admitted to four major hospitals in Bandung, Indonesia. A dengue serological test was performed on 1,100 (85%) of the patients with a positive result in 763 (69%), HI test on 243 patients (22%), IgG dengue blot on 489 patients (44%) and IgM dengue blot on 25 patients (2.3%). Since an accurate diagnosis was found only in a small proportion of the cases (positive HI test), all the clinically-diagnosed DHF/DSS cases were analysed. Thrombocyte count of less than 100,000/μl was present in 445 (34%) cases on admission and in 637 (49%) cases during hospitalization. In the serologically-confirmed cases, the prevalence of thrombocytopenia (count less than 100,000/μl) was 58% on admission and 83% during hospitalization. Severe bleeding was recorded in 76 (6%) of all DHF/DSS cases and occurred more often in patients with severe thrombocytopenia. O ne hundred and fifty-six (12%) DHF/DSS cases received a platelet transfusion; among them only 30 (19%) had a platelet count below 25,000/μl. No difference in the frequency of bleeding was observed comparing patients who received or those who did not receive a platelet transfusion (even in those with a platelet count < 25,000/μl). In conclusion, a large number of patients with DHF/DSS in Bandung hospitals receive platelet transfusions, even if thrombocyte counts are above 25,000/μl. This study suggests that in most DHF/DSS cases, platelet transfusions do not influence the incidence of severe bleeding. Treatment costs for DHF/DSS cases could be reduced if these unnecessary platelet transfusions are avoided. Further studies undertaken only in accurately confirmed cases are needed to clarify this finding.