Researchers collaborating from Singapore and Malaysia have found that it is ineffective to administer blood transfusions to adult dengue patients with low serum platelet counts and without severe bleeding.

According to Associate Professor Dr Sharifah Faridah Syed-Omar, head of the infectious diseases unit at Universiti Malaya Medical Centre (UMMC), the study revealed that routine platelet transfusions neither resulted in early platelet count recovery nor prevented clinical or severe bleeding from occurring in patients.

“Based on this study, we do not recommend routine platelet transfusion in patients with dengue fever,” Sharifah added.

Prophylactic transfusion with platelets not recommended in Malaysian CPG

Dengue is a common vector-borne infection which is prevalent in Malaysia, often with higher transmission rates during the rainy season. According to Health director-general Datuk Dr Noor Hisham Abdullah, the cumulative incidences of dengue fever from January to 25 February this year stood at 14,513 cases, compared to 25,403 cases reported during the same period in 2016.

Dengue infection is often associated with thrombocytopenia and coagulation abnormalities, which may result in bleeding. Based on the 2015 Clinical Practice Guidelines for Management of Dengue Infection in Adults by the Malaysian Ministry of Health (MOH), however, routine prophylactic transfusion with platelets and fresh frozen plasma has no role in the management of dengue infection.

However, researchers noted that, “prophylactic platelet transfusion is widely used despite the dearth of robust evidence.”

Transfusion linked to adverse events

Between 29 April 2010 and 9 December 2014, researchers from Singapore and Malaysia conducted a clinical trial to assess the efficacy and safety of prophylactic platelet transfusion in adult patients with dengue infection and thrombocytopenia.

The study, titled “Prophylactic platelet transfusion plus supportive care versus supportive care alone in adults with dengue and thrombocytopenia: a multicentre, open-label, randomised, superiority trial,” was conducted across five hospitals in Singapore and Malaysia, involving 372 patients aged 21 years and above with identified or probable dengue and thrombocytopenia without persistent mild or any severe bleeding.

From the trial, researchers found that bleeding did not stop in patients with thrombocytopenia who did not suffer from severe bleeding despite platelet transfusions, compared to patients from the control group.

They also highlighted that significantly more adverse events occurred in patients who received transfusions, including three incidences of urticaria, one case of maculopapular rash, one of pruritus, one of chest pain, and one incident each of anaphylaxis, transfusion-related acute lung injury as well as fluid overload, although all events were resolved.

In lieu of the scarcity of blood products as well as the potential safety concerns of blood products in settings with limited resources, the researchers concluded that platelet transfusion for dengue patients without complications cannot be recommended as there was no known benefit in reduction of bleeding or any improvement in platelet count.

“The mainstay of treatment for dengue remains supportive with careful administration of fluids to treat plasma leakage that occurs in severe dengue,” said Sharifah. MIMS

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