Dengue patients do not die of platelet deficiency but of intravascular leakage

Health Care, Medicine 68 Comments

As per international guidelines, unless the platelet count is less than 2% of base line levels AND there is spontaneous active bleeding, no platelet transfusion is required.

The cause of death in dengue is capillary leakage causing blood deficiency in vascular department, leading to multiorgan failure. At the first instance of plasma leakage from intravascular compartment to extravascular compartment, one needs to give 20 ml per kg body weight per hour of fluid replacement to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Leakage normally occurs after the fever is over.

Giving unnecessary platelet transfusion to the patient can harm the individual.
I have created a Formula of 20 for the family doctors to decide about admission of a case of dengue.
a. There is a rise in pulse by 20.
b. There is a fall in the upper (systolic) blood pressure by 20 mmHg.
c. The pulse pressure (difference between upper and lower blood pressure) is lower than 20.
d. The hematocrit (thickness of blood) increases by 20%.
e. Platelet count is less than 20,000.
f. There are more than 20 petechiae (bleeding spots) in the tourniquet test in one square inch area.