Audit of Platelet Usage in Dengue Patients
Journal Title: Journal of Medical Research and Practice - Year 2017, Vol 6, Issue 1
Abstract
A retrospective study was conducted to evaluate the appropriateness of platelet transfusion done in dengue patients with IgM or NS1 serology positivity. The study was conducted on 695 serologically confirmed dengue patients admitted at the Pondicherry Institute of Medical Sciences between September 1, and December 31, 2012. Clinical data, platelet count and platelet requirements were analyzed and tabulated. Among the 695, serologically confirmed cases, 162 (23.31%) patients of dengue cases received platelet transfusion. The clinical data were available only for 98 patients who received a total of 150 transfusions. Among them, 88 (58.66%) transfusions had a platelet count ≤ 20,000/mm3, while the remaining 62 (41.34%) transfusions had platelet count > 20,000/mm3. Out of 62 transfusions, 26 transfusions had haemorrhagic manifestations such as petechiae, gum bleeding, epistaxis etc., which necessitates the use of platelet transfusion. However, the remaining 36 transfusions with platelet count > 20,000/mm3 had no haemorrhagic manifestations and hence received inappropriate platelet transfusion. 24% of platelet transfusions were inappropriate. The percentage of inappropriate transfusion is lower than the other studies and the difference is highly statistically significant. Further, it is seen that 56.6% of bleeding manifestations occurred with platelet count > 20000/mm3 of blood and only 43.3% of bleeding manifestations occurred with platelet count ≤ 20000/mm3 of blood. This demonstrates that there is no significant relationship between clinical bleeding and platelet counts. Nearly 35 transfusions (26%) showed negative or nil response to transfusion. Further, it is also seen that more number of refractoriness to platelets were seen in transfusions which were inappropriate. And nearly 35 transfusions (26%) showed negative or nil response to transfusion. The decreased response or nil response was seen mostly (33%) in transfusions which were inappropriate, than in transfusions which were appropriate (19%). There were scarcely any post-transfusional reactions seen in the patients. From our study, it is clear that there is a decrease in inappropriateness from the previous years. It is strongly recommended to conduct further studies to understand the mechanism of thrombocytopenia and hemorrhage in dengue and if there is a requirement of platelet transfusion in dengue.
Authors and Affiliations
N. Kaviyapriya
Keywords
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