The department of transfusion medicine at the hospital conducted this study on 531 dengue patients, including 376 men and 155 women. It has been published in a recent issue of the Transfusion Medicine and Hemotherapy , an international medical journal. Researchers claim that many patients were given prophylactic transfusion to allay anxiety , both among the patient and the treating physician regarding worsening of condition. TOI spoke to Dr Bharat Singh, who heads Delhi State Blood Transfusion Centre, on the issue. He said that inappropriate platelet transfusion is common among all hospitals, both public and private.
“Many clinicians are uninformed about the condition where platelet transfusion is necessary. Others succumb to pressure from patient’s family members,” Dr Singh added.
Platelet is a blood component that helps in clotting.The normal platelet count in human beings ranges between 1.5 to 4 lakh. In dengue fever, there is increased destruction of platelets and reduction in the formation of new ones which leads to low platelet count, say doctors.
While transfusion in patients with platelet count less than 20,000 units and clinical parameters such as bleeding or rashes is important to check hemorrhage, doctors say prophylactic transfusion can be counter-productive as it triggers an immune response.
“Our analysis on need for platelet transfusion is from the perspective of a pathologist. Physicians may have their own explanation for administering it,” said Dr Kabita Chatterjee, faculty-incharge of the blood bank at AIIMS, who was part of the study.
Experts said cancer patients are major consumers of platelet products. “In developing countries like India, where the component separation facilities are limited, optimal usage of platelet products is of paramount importance, especially during periods of increased demands such as dengue epidemics so that other needy patients are not deprived of it,” said an expert.
He said educating clinicians about evidence-based transfusion practices is needed to reduce inappropriate transfusions and decrease the strain on facilities, especially at the time of epidemics. Experts also stress on the need for constitution of hospital transfusion committee and close coordination between facilities and physicians ordering blood components to ensure optimal utilisation of scarce resources.
This year, Delhi saw one of the worst outbreaks in decades with over 15,000 confirmed cases and 38 deaths. “Many needy patients struggled to get beds in hospitals. Due to panic, even those with high platelet count insisted on transfusion,” said a doctor.
Termed by many experts as the world’s most rapidly spreading viral disease, dengue is caused by four serotypes. While type I and III are mild causing classic dengue fever and fever without shock, respectively , dengue type II and IV are considered deadly . These cause fever, bleeding and a drop in platelet count. This year, studies have shown, type II and type IV were dominant strains.
