Dengue awareness
Platelet deficiency is not the cause of death in people
suffering from Dengue
According to International guidelines, unless a patient’s
platelet count is below 10,000, and there is spontaneous, active bleeding, no
platelet transfusion is required. The outbreak of dengue in the City and
Hospital beds are full and families are seen running around in search of
platelets for transfusion. However what most people do not realize is that the
first line of treatment for dengue is not platelet transfusion. It, in fact,
does more harm than good if used in a patient whose counts are over 10,000.
The primary cause of death in patients suffering from
dengue is capillary leakage, which causes blood deficiency in the intravascular
compartment, leading to multi-organ failure. At the first instance of plasma
leakage from the intravascular compartment to the extravascular compartment,
fluid replacement amounting to 20 ml per kg body weight per hour must be
administered. This must be continued till the difference between the upper and
lower blood pressure is over 40 mmHg, or the patient passes adequate urine.
This is all that is required to treat the patient. Giving unnecessary platelet
transfusion can make the patient more unwell.
“While treating dengue patients, physicians should
remember the ‘Formula of 20' i.e. rise in pulse by more than 20; fall of BP by
more than 20; difference between lower and upper BP of less than 20 and
presence of more than 20 hemorrhagic spots on the arm after a tourniquet test
suggest a high-risk situation and the person needs immediate medical
attention.”
Dengue fever is a painful mosquito-borne disease. It is
caused by any one of four types of dengue virus, which is transmitted by the
bite of an infected female Aedes aegypti mosquito. Common symptoms of dengue
include high fever, runny nose, a mild skin rash, cough, and pain behind the
eyes and in the joints. However, some people may develop a red and white patchy
skin rash followed by loss of appetite, nausea, vomiting, etc. Patients
suffering from dengue should seek medical advice, rest and drink plenty of
fluids.
Paracetamol can be taken to bring down fever and reduce
joint pains. However, aspirin or ibuprofen should not be taken since they can
increase the risk of bleeding.
Read also:
- Dengue awareness
- How To Treat Low Blood Sugar (Hypoglycemia)
- Eye Disorders and Diseases
- Heart Attack Symptoms, Risk, and Recovery
- Heart Failure
- ANTIRHEUMATIC DRUGS
- Diabetes and types of Diabetes
- High Blood Pressure Symptoms and Causes
The risk of complications is in less than 1% of dengue
cases and, if warning signals are known to the public, all deaths from dengue
can be avoided.
DENGUE NS1-Best test is NS1
Cannot be false +ve
Is + from day 1 to 7 ideally.
If on day 1 is -ve, repeat it next day.
Always ask for ELISA based NS1 tests as card tests are
misleading.
Value of IgG & IgM dengue-
In a pt with reduced platelets and looking
"sick" on day 3 or 4 of illness, a very high titre of IgG with
borderline rise in IgM signifies secondary dengue. These pts are more prone to
complications.
In primary dengue IgG becomes + at end of 7 days, while
IgM is + after day 4.
Immature Platelet fraction/IPF
A very useful test in Dengue for pts with
thrombocytopenia.
If IPF in such a pt is > 10%, despite a pl count of
20, 000 he is out of danger & platelets will rise in 24 hrs
If its 6%, repeat the same next day. Now if IPF has
increased to 8% his platelets will certainly increase within 48 hrs.
If its less then 5%, then his bone marrow will not
respond for 3-4 days & may be a likely candidate for pl transfusion.
Better to do an IPF even with borderline low platelet
count.
A low Mean Platelet volume
or MPV means platelets are functionally inefficient and
such patients need more attention.
See Also: Dengue Symptoms and Treatment
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