Contrary to popular belief that dengue patients die due to platelet deficiency, I must inform you that the cause of death in such cases is primarily due to capillary leakage, which leads to blood deficiency.
ACCORDING TO international guidelines, unless the platelet count is below 10,000 or there is spontaneous active bleeding, no platelet transfusion is required. The cause of death in 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 intravascular compartment to extra-vascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual.
Here is my ‘Formula of 20’ for family doctors to understand the severity of dengue.
- Rise in pulse by 20
- Fall in upper blood pressure by 20 mmHg
- Pulse pressure is lower than 20
- Hematocrit increased by 20%
- Platelet count is less than 20,000
- More than 20 petechiae in the tourniquet test