Prospective observational study of low thresholds for platelet transfusion in adult dengue patients

BACKGROUND: The practice of platelet (PLT) transfusions has been adopted into the standard clinical practice in many dengue-endemic countries. Because many patients were found to have received unnecessary PLT transfusions, the development of guidelines for the management of dengue patients with thrombocytopenia has become a necessity. STUDY DESIGN AND METHODS: An emergency department―based prospective observational study was conducted in Martinique during a dengue outbreak in adult patients presenting with an acute febrile illness. Patients with severe bleeding and/or who underwent invasive intensive care procedures or emergency surgery were given PLT transfusion to achieve PLT counts of more than 50 x 10 9 /L. PLT transfusion was also considered for patients with PLT counts of less than 5 x 10 9 /L and for those with associated risk factors and PLT counts of less than 20 x 10 9 /L. RESULTS: A total of 350 patients were admitted with confirmed dengue infections. Most of them had secondary serotype-2 infections. PLT counts of less than 50 x 10 9 /L were recorded in 165 patients (47.1 %). PLT transfusion was administered to 9 patients with thrombocytopenia. The indications included severe bleeding (5 cases), invasive procedures (3 cases), emergency surgery (1 case), and/or associated risk factors (2 cases). The median time duration from the onset of fever to PLT transfusion was 6 days (range, 4-10 days). The median amount of PLTs transfused was 3.66 x 10" (range, 2.8 x 10"-13.2 x 10 11 ). The median PLT yield was +12.4% (range, ―3.9% to +67.1%). Three patients died. All other patients recovered during the second week after the onset of fever. CONCLUSION: A restrictive strategy for PLT transfusion based on clinical features and low PLT count thresholds proved to be feasible and safe for adult dengue patients.