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.


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(11) (range, 2.8 x 10(11)-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.


CONCLUSIONS
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.
Thomas
Laurent
L
Service des Urgences, Hôpital Pierre Zobda Quitman, Centre Hospitalier Universitaire, Fort-de-France, Martinique. laurent.thomas@chu-fortdefrance.fr
Kaidomar
Stéphane
S
Kerob-Bauchet
Brigitte
B
Moravie
Victor
V
Brouste
Yannick
Y
King
Jean Philippe
JP
Schmitt
Sarah
S
Besnier
François
F
Abel
Sylvie
S
Mehdaoui
Hossein
H
Plumelle
Yves
Y
Najioullah
Fatiha
F
Fonteau
Christiane
C
Richard
Pascale
P
Césaire
Raymond
R
Cabié
André
A