Dengue is the most important arboviral infection of humans. Thrombocytopenia is frequently observed in the course of infection and haemorrhage may occur in severe disease. The degree of thrombocytopenia correlates with the severity of infection, and may contribute to the risk of haemorrhage. As a result of this prophylactic platelet transfusions are sometimes advocated for the prevention of haemorrhage. There is currently no evidence to support this practice, and platelet transfusions are costly and sometimes harmful. We conducted a global survey to assess the different approaches to the use of platelets in dengue. Respondents were all physicians involved with the treatment of patients with dengue. Respondents were asked that their answers reflected what they would do if they were the treating physician. We received responses from 306 physicians from 20 different countries. The heterogeneity of the responses highlights the variation in clinical practice and lack of an evidence base in this area and underscores the importance of prospective clinical trials to address this key question in the clinical management of patients with dengue.
References
[1]
Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, et al. (2010) Dengue: a continuing global threat. Nat Rev Microbiol 8: S7–S16. doi: 10.1038/nrmicro2460
[2]
Lee VJ, Lye DC, Sun Y, Fernandez G, Ong A, et al. (2008) Predictive value of simple clinical and laboratory variables for dengue hemorrhagic fever in adults. J Clin Virol 42: 34–39. doi: 10.1016/j.jcv.2007.12.017
[3]
La Russa VF, Innis BL (1995) Mechanisms of dengue virus-induced bone marrow suppression. Baillieres Clin Haematol 8: 249–270. doi: 10.1016/S0950-3536(05)80240-9
[4]
Lei HY, Yeh TM, Liu HS, Lin YS, Chen SH, et al. (2001) Immunopathogenesis of dengue virus infection. J Biomed Sci 8: 377–388. doi: 54058
[5]
Alonzo MT, Lacuesta TL, Dimaano EM, Kurosu T, Suarez LA, et al. (2012) Platelet apoptosis and apoptotic platelet clearance by macrophages in secondary dengue virus infections. J Infect Dis 205: 1321–1329. doi: 10.1093/infdis/jis180
[6]
Krishnamurti C, Kalayanarooj S, Cutting MA, Peat RA, Rothwell SW, et al. (2001) Mechanisms of hemorrhage in dengue without circulatory collapse. Am J Trop Med Hyg 65: 840–847.
[7]
Noisakran S, Chokephaibulkit K, Songprakhon P, Onlamoon N, Hsiao HM, et al. (2009) A re-evaluation of the mechanisms leading to dengue hemorrhagic fever. Ann N Y Acad Sci 1171: E24–35. doi: 10.1111/j.1749-6632.2009.05050.x
[8]
WHO (2009) Dengue: guidelines for diagnosis, treatment, prevention and control - New edition. Geneva: World Health Organisation.
[9]
WHO (2011) Comprehensive guidelines for the prevention and control of dengue and dengue haemorrhagic fever, revised and expanded edition. Delhi.
[10]
India Go (2008) Guidelines for clinical management of dengue fever, dengue haemorrhagic fever and dengue shock syndrome. Delhi.
[11]
Verdeal J, Filho RC, Vanzillotta C, Macedo G, Bozza F, et al. (2011) Guidelines for the management of patients with severe forms of dengue. Rev Bras Ter Intensiva 23: 125–133. doi: 10.5005/jp/books/11080_20
[12]
Lum LC, Abdel-Latif Mel A, Goh AY, Chan PW, Lam SK (2003) Preventive transfusion in Dengue shock syndrome-is it necessary? J Pediatr 143: 682–684. doi: 10.1067/S0022-3476(03)00503-1
[13]
Lye DC, Lee VJ, Sun Y, Leo YS (2009) Lack of efficacy of prophylactic platelet transfusion for severe thrombocytopenia in adults with acute uncomplicated dengue infection. Clin Infect Dis 48: 1262–1265. doi: 10.1086/597773
[14]
Kurukularatne C, Dimatatac F, Teo DL, Lye DC, Leo YS (2011) When less is more: can we abandon prophylactic platelet transfusion in Dengue fever? Ann Acad Med Singapore 40: 539–537. doi: 10.5005/jp/books/11080_20
[15]
Sharma A, Charles K, Chadee D, Teelucksingh S (2012) Dengue hemorrhagic Fever in trinidad and tobago: a case for a conservative approach to platelet transfusion. Am J Trop Med Hyg 86: 531–535. doi: 10.4269/ajtmh.2012.10-0209