Platelet Transfusion Practice in Dengue Epidemic; Current Trends and Challenges – an Institutional Study

Abstract

Introduction: Dengue is an arboviral disease with an inherited risk associated with the transfusion of blood components and to prevent unnecessary transfusion during dengue epidemic a standard criteria has to be followed. Aims/objectives: To record clinical features, laboratory investigations and management of hospitalized seropositive dengue patients. To review the appropriateness of platelet transfusion practices in order to ensure optimal utilization of platelets. Material and methods: The Retrospective study is being done at RL Jalappa Medical Hospital from April 2015 to June 2019 on seropositive dengue cases. All serologically confirmed dengue cases who received platelet transfusion were included in the study. Patient’s clinical data and platelet counts were obtained from platelet requisition forms and Medical Record Department. Case definition of Dengue/DHF/DSS applied in the present study was as recommended by WHO4 i.e. Guidelines for platelet transfusion in R. L. Jallappa Hospital Hospital were utilized as the criteria to assess the appropriateness of platelet transfusion adapted from British Committee for Standardization in Hematology (BCSH) has recommended a platelet count <10000/cmm for prophylactic platelet transfusion in those with no other risk factors which would increase the risk of bleeding. Statistical analysis: Data management and analysis was done by SPSS version 22.0. Results: During study period total of 1361 cases were diagnosed as dengue infection (out of which 757-males, 604-females). Maximum cases were seen in the age group of 11-18. All patients were categorized as per WHO dengue case classification into Dengue Fever, Dengue Haemorrhagic Fever, and Dengue Shock syndrome. In which 72.5% of patients were DF, 23.4% were DHF and 4% of DSS. In present study, maximum number of Patients and platelets transfused was seen when platelet count was 11-20 × 1000/cmm that is 777 units in which RDP was 697 and SDP was 80 and lowest number of platelets transfused was seen when platelet count was >60. A total of 2705 RDP and 359 SDP were transfused to 1361 patients, of these 1361 patients, 316 bleeding patient received PT and 1045 non bleeding patient received prophylactic platelet transfusion in which 140 patient was requiring actual platelet transfusion and 905 patients were not needed. Conclusion: Inappropriate usage of platelets leads to shortage of platelets. Strict adherence to British Committee for Standardization in Hematology (BCSH) Guidelines will optimize platelet usage with this true DHF and DSS will be benefited during epidemic outbreaks. Educating patients and Patients attenders will help reducing anxiety and this in turn help clinician for better judgment on evidence based transfusion reducing inappropriate transfusion. This study emphasis on platelet usage trends in regional areas and highlighting.