Doctors infuse platelets at 50,000 count, dengue panic syndrome grips Hyderabad

HYDERABAD: With a spurt in fever cases, dengue panic syndrome has gripped the city, resulting in more and more Hyderabadis landing in intensive care units (ICUs) of hospitals. However, a TOI investigation has revealed that patients with platelet counts around 50,000 are also being put in the Intensive Care Unit(ICU), which is not only burning a hole in their pockets, but some being recommended the unnecessary platelet transfusion.
In severe cases, ‘platelet transfusion’ might be required, but not unless the count goes below 10,000-20,000.The normal presentation of the disease is sudden onset of highgrade fever, severe muscle pains, headache, pain behind the eyes, vomiting, rash, low white blood count and low platelet count. It is the last feature i.e., low platelet count that instils fear in patients and treating physicians. Platelets form blood clots to seal any injured or bleeding site. The normal platelet count is usually maintained in a range of 1.5 lakh to 4.5 lakh/mm3.

“Unfortunately, patients, their relatives as well as healthcare workers tend to ‘chase’ the platelet count. Even patients who test positive for dengue actually have a mild disease and can be safely treated and monitored on an out-patient basis. There is such a fear in the general population that they tend to chose to get admitted to hospital rather than stay at home,” Dr Rahul Agarwal, consultant internal medicine, Maxcure Hospitals, said.
It is not until the platelet count reaches 10,000 to 20,000/ mm3, the risk of spontaneous bleeding rises. “In many dengue patients, there isn’t any need to transfuse platelets until this threshold is reached. About 70-80% cases need temporary management like controlling fever and electrolytes. Only in case of patients who have lower than 50,000 platelet count and complications like high-grade fever or renal failure, it is not necessary to monitor them in ICU,” said Dr Sanjeev Singh Yadav, president Indian Medical Association-Hyderabad unit.