To avoid unwanted blood transfusion during dengue test

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During dengue immature platelet fraction (IPF) test with unwanted blood transfusion-related complications can be prevented.

If the IPF, a modern parameter that measures young and thereby reticulated platelets in peripheral blood, is high then there is no requirement of blood transfusion in a dengue patient even if there were initial indications of its requirement, the doctors said.

Under current treatment guidelines, dengue patients whose platelet count of 20,000 per cubic millimeter are thought to have been knocked down may be at high risk of bleeding and platelet transfusions to offer. Platelets are blood cells that help the clotting process.

The two teams of doctors, through independent studies on 50 patients in Delhi and 32 in Mumbai, have shown that the fraction of immature platelets in a dengue patient's bloodstream may be a more reliable indicator of dengue severity than the absolute platelet count.

The increased production of platelets in the bone marrow level rise IPF. Therefore, the measurement of a reticulocyte count red cells may provide a measure of output to a similar manner, a peripheral blood sample provides an assessment of bone marrow platelet production.

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The study was conducted on 50 dengue patients who had platelet count less than 1, 00,000/cumm and admitted to Ganga Ram Hospital last year.
According to guidelines, platelet transfusion is indicated when its count is less than 20,000/cumm or if the patient has bleeding.
The indications of transfusion were present in 18 patients during the study. However, only 12 patients out of 18 (66.66 per cent) received appropriate transfusion.

In six of the 18 (33 per cent) patients, platelet transfusion was deferred as their immature platelet fraction values were high. Thus the IPF helped prevent platelet transfusion in one-third of the patients who would have received a platelet transfusion.

"This is the first study in which we found Immature Platelet Fraction test useful. IPF can be taken as an indicator of bone marrow recovery from insult caused by the dengue virus. Its values can be taken as an indicator of requirement platelet transfusion. The same can be deferred if immature platelet fraction values are high, the patient is not bleeding and the blood pressure is stable.”

Finding the utility of IPF in reducing the need for platelet transfusion in large number of dengue patients, the department of internal medicine and the hematology department are using the test to monitor platelets in dengue patients.

South Delhi Municipal Corporation, the nodal agency for maintaining a record of dengue and chikungunya cases, said Delhi so far has witnessed over 400 cases of dengue and chikungunya each.

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