Recently, Abhimanyu Singh (name changed), a resident of Basaveshwara Nagar was suspected of dengue fever and admitted in M S Ramaiah Hospital, one of the major hospitals in Bangalore. In one day, his blood platelet count dropped steeply, from 2.4 lakh to 56,000, symptomatic of dengue.
People in the waiting room at K C General Hospital in Malleshwaram. pic: Vaishnavi Vittal
Doctors kept a close watch on the patient and geared up for a platelet transfusion if the platelet count dipped any further. The plan was to perform platelet transfusion only if the count were to go below 30,000. Luckily for him, the platelet count never went below 56,000.
What is a platelet?
This is one of the components of blood that helps in clotting and coagulation of blood. After an injury, bleeding stops after some time because of the blood clotting. In this whole mechanism, platelets play an important role.
Dipping count, panic, and the reality
Should a friend or relative close to you suffering from dengue require a platelet transfusion urgently, is there a need to panic? Citizen Matters talked to several expert doctors and here is what you need to know.
The normal blood platelet count in humans range between 1.5-4 lakh. When affected by dengue fever, platelet count falls. This puts the patient at risk of bleeding and hemorrhage, since blood loses its clotting and coagulating ability. The prevent this, platelet transfusion into the patient may become necessary.
According to WHO guidelines cited by doctors, transfusion is mandated when platelet count decreases below 20,000.
Dr Sudarshan Ballal, Medical Director, Manipal Hospital, Bangalore says, the decision to transfuse platelets is up to the patient’s doctor. He adds, “However, if the count goes below 10,000 or if there is a tendency to bleed irrespective of the blood count, the transfusion is warranted.”
Madan S Gaekwad, Sagar Hospitals and Vice-President of PHANA (Private Hospital And Nursing Homes Association Bangalore) says that the platelet transfusion depends on the clinical condition of the patient. He adds, “A thorough clinical assessment is done and if required, platelet are transfused when the count hits 40,000.” He also mentions that the patient may start bleeding if they do not transfuse early enough.
Different doctors have different opinions regarding transfusion. Rajat Kumar Agarwal, President of Sankalp India Foundation, a network of blood banks in Karnataka explains that following the WHO (World Health Organisation) guidelines, i.e transfusion below 20,000 counts, is tricky. He says that platelet counts fall suddenly and rapidly and adds, “It would risk a patient’s life, so the doctors start the (transfusion) process early. But, at the same time when doctors think of early transfusion the platelet reserves may end soon.”
Stagnant water bodies are also breeding grounds for mosquitoes. Pic: Supriya Khandekar
Dr P G Subramanian, Tata Cancer Institute, Mumbai also confirmed that a platelet count of 20,000 and above is considered safe if the patient has no other complications. Also, he explains, “Doctors do not usually wait till the 20,000 condition is reached, before taking a decision on transfusion, since it can take 24 hours at least to get a blood donor and extract platelets. So doctors may make the requests at a level above 20,000 itself, if they see the count falling.”
Subramanian adds that majority of dengue cases do not see fall in platelet count and that platelet transfusion is not the only treatment for Dengue patients. He adds, “In elderly patients, multiple complications can arise, then transfusion of platelets alone will not help. Doctors will likely be doing other treatments too.”
How platelets are extracted
Within 6 hours of collecting blood, platelets are extracted with special component separation machines. These platelets are stored under different conditions, unlike blood and must be used within 5 days.
In case of an emergency, platelets are procured from blood banks. Almost all major blood banks have component separation facilities.
Major hospitals adopt Single Donor Platelet Apheresis – a process that enables extraction of up to 300 ml of platelets from a single donor in one go. This process injects the blood back to the donor’s body, after extracting the platelets.
The symptoms of dengue fever includes sudden high fever, severe headaches, muscle and joint pains, vomiting, pain behind the eye etc. There is another severe form of dengue named dengue hemorrhagic fever (DHF) and if not treated properly, it can be fatal.
The disease spread can be controlled by combating mosquitoes.
- Prevent mosquitoes from breeding in stagnant water.
- Dispose trash properly
- Keep water storage containers clean and covered
- Use mosquito repellents.
Situation in Bangalore
Almost a third of the total dengue cases in Karnataka in 2012, are from Bangalore. According to the statistics provided by National Vector Borne Disease control program, Karnataka saw 3347 positive dengue cases in 2012, in which Bangalore counts around 1000. Out of the 21 deaths in Karnataka attributed to dengue, eight occurred in Bangalore.⊕