Gloved hand using a pipette to collect blood for lab examination
Dengue Fever is a mosquito-transmitted disease typically characterized by a considerable decrease in platelet levels and a risk of hemorrhagic complications. It can be fatal without rapid medical management. Plateletpheresis is one method of rapidly increasing platelet count in patients with severe thrombocytopenia and actively bleeding dengue.
It involves an apheresis machine to collect and administer purified,d concentrated platelets from one donor to a patient to reestablish the circulating platelet counts quickly and efficiently. Careful observation and use in cases with appropriate indications are necessary to prevent unnecessary transfusion.
Plateletpheresis is a specialised component of a blood separation procedure to obtain concentrated platelets from a single healthy donor for infusion. It has found application in thrombocytopenic states, such as in the case of Dengue Fever, where platelet loss is of clinical importance, to rapidly enhance circulating platelet levels. It differs from whole blood donation in that it makes use of an automated apheresis machine where blood is selectively removed, platelets are isolated, and the returned blood components are returned to the donor.
The resultant product is single donor platelets, which contain higher concentrations of platelets and minimal donor risk compared to random donor platelets. This therapy is crucial in patients with profound thrombocytopenia or those with active bleeding, when restoration of platelet levels to a sufficient degree is necessary to achieve hemostasis.
Plateletpheresis is a specific and efficient strategy in the management of dengue for augmentation of platelets. It helps to maintain an adequate platelet count in those patients who require transfusion while minimizing risks from donor exposure. However, indications must be clearly defined, since not all thrombocytopenic Dengue patients may require platelet transfusions.
Thrombocytopenia is one of the most consistent hematological findings in dengue fever. Platelet count typically follows a reproducible and progressive pattern of decrease during acute infection.
Studies have demonstrated that the pattern of decrease of platelet count follows a biphasic course starting from day 3 of infection, dropping to a lowest point on day 6 (mean 97 10/L) and thereafter on day 9 recovering to baseline values. About 50% patients develop moderate thrombocytopenia (50-99 10/L), while in 14-15% patients, the platelet counts drop significantly ( severe thrombocytopenia (<50 10/L).
Platelet decline occurs along with an increase in lymphocyte percentage (~40%) and a reduction in neutrophils (~46%), supporting immune mechanisms. Inverse correlation between platelet count and viral load demonstrates viral replication in destroying platelets in addition to bone marrow suppression and consumption.
The normal range for platelets is 150–400 X 10 9/L. Thrombocytopenia is frequently present in Dengue infection, with studies showing a biphasic drop in platelet count with a nadir around day 6 (average platelet count 97.65 X 109/L), followed by a rise on day 9. Generally, there is a moderate thrombocytopenia in about 50% of patients (50–99 X 109/L), although approximately 14.8% develop a profound thrombocytopenia (<50 X 10 9/L)2. The rate of progression of moderate to severe Dengue is not high, even with low platelets,s unless other danger signals are present.
Plateletpheresis (platelet transfusion) has no role in patients with uncomplicated Dengue fever; it is only recommended in patients with severe thrombocytopenia who have either:
Routine prophylactic platelet transfusion should be avoided as there is a positive correlation between the degree of thrombocytopenia and the degree of viremia and an immune response, rather than any increased risk of bleeding.
A clear diagram of red blood cells, complete with DNA
A large dose of platelets is delivered rapidly and is effective at boosting patient platelet counts during a state of marked thrombocytopenia, particularly when the platelet count is below 10-20 10/L.
Also effective at controlling or preventing active bleeding from various sites, especially mucosal or GI hemorrhage, by augmenting hemostasis at the most vulnerable stage of dengue.
Platelets are derived from a single donor, so the number of donors the patient is exposed to is less than that of pooled platelet transfusions, which, therefore, reduces the risk of transfusion-associated infection and alloimmunization.
With the capability to match platelet antigens better, we can prescribe the correct dose to achieve a better outcome and an unnecessarily large volume load to the patient.
Platelet transfusions given during the nadir of dengue ( day 5-7) are of critical importance and are potentially life-saving by stabilizing patients.
In Dengue fever, routine prophylactic transfusion is usually not necessary because a low platelet count doesn't necessarily correlate with bleeding tendency.
Since transfused platelets are often rapidly destroyed (immune destruction or viral suppression, they can often be depleted and are not beneficial long-term.
Possible symptoms range from febrile reactions to allergic reactions and potentially life-threatening TRALI.
Requires apheresis equipment and trained staff, as well as sufficient donors, which are costly to supply, and therefore less readily available in areas lacking resources.
Can overload patients with fluids, and is an additional burden to health services without an obvious benefit.
Platelet Transfusion Guidelines Platelet transfusion is a life-saving therapy for thrombocytopenia and should be guided by both the clinical picture and platelet count. Prophylaxis should generally occur with counts <10-20 10/L, and <50 10/L when there is bleeding, surgery, or dengue fever. Standard indications and guidelines for the selection of ABO-compatible platelets should be followed, and infusions should be carried out aseptically with close monitoring.
Effective and rational evidence-based transfusion management will prevent a range of complications.
Plateletpheresis serves as a focused and supportive measure to help mitigate the consequences of critical thrombocytopenia resulting from dengue infection in the presence of ongoing bleeding, as well as critically depleted levels.
While it achieves effective replacement of platelets and improvement in hemostasis, it is critical that its usage be guided by robust clinical data and be clinically warranted in all patients. It must be emphasized that most patients are managed with solely supportive treatment, as a drop in the platelet count is often transient.
It should therefore never be performed unnecessarily. Monitoring and adherence to guidelines, and appropriate evaluation of the patient, are of paramount importance.
A person donating blood by sitting with a medical tube.
1. Asian Journal of Pharmaceutical and Clinical Research: https://journals.innovareacademics.in/index.php/ajpcr/article/view/47464
2. National Library of Medicine: https://pmc.ncbi.nlm.nih.gov/articles/PMC12409373/
3. Science Direct: https://www.sciencedirect.com/science/article/pii/S2052297525000630
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