No Benefit of Prophylactic Platelet Transfusion for Bleeding Prevention in Dengue

In an open-label randomized trial described in the Lancet, researchers in Singapore and Malaysia discovered that prophylactic platelet transfusion was not superior to supportive care in the prevention of bleeding in adult patients with dengue and thrombocytopenia, and may even result in adverse events.¹

Dengue, the most common vector-borne infection, affects approximately 390 million people worldwide, and has been linked with significant healthcare and economic costs.^2,3 Prophylactic platelet transfusion is often used to prevent bleeding in dengue and thrombocytopenia, which occurs in up to 100% of patients with dengue, though there is insufficient data supporting this practice. In fact, numerous studies have found that it was not only ineffective but resulted in a range of negative outcomes, from fluid overload and longer hospital stays to severe transfusion reactions and death.^4,5

The current research examined the efficacy and safety of this strategy in 369 patients across 4 hospitals. Patients were randomly assigned to receive supportive care (n=182) consisting of bed rest, fluid intake, and medications to treat fever and pain, or supportive care plus prophylactic platelet transfusion (n=187), which was administered when the platelet count dropped to or below 20,000/µL. 

Results show that the primary outcome — clinical bleeding by day 7 or at hospital discharge — occurred in 21% of patients in the transfusion group vs 26% of patients in the control group (risk difference –4.98% [95% CI, –15.08 to 5.34]; relative risk [RR] 0.81 [95% CI, 0.56–1.17]; P =.16).

In the transfusion group, 13 adverse events were observed vs 2 in the control group (risk difference 5.81% [95% CI, –4.42-16.01]; RR 6.26 [95% CI, 1.43-27.34]; P =.0064). Adverse events that were definitely or likely associated with transfusion included 3 cases of urticaria and 1 case each of maculopapular rash, pruritus, chest pain, anaphylaxis, transfusion-related acute lung injury, and fluid overload.

Overall, these findings demonstrate no benefit of prophylactic platelet transfusion compared with supportive care alone in preventing bleeding in adult patients with dengue and low platelet count. In addition, patients in the transfusion group experienced significantly more adverse events than the supportive care group.

“In view of the scarcity and potential safety concerns of blood products in resource-limited settings, prophylactic platelet transfusion for patients with uncomplicated dengue is not recommended, since no benefit in reduction of clinical or severe bleeding or improvement in platelet count recovery was shown,” the investigators wrote.

References

1. Lye DC, Archuleta S, Syed-Omar SF, et al. Prophylactic platelet transfusion plus supportive care versus supportive care alone in adults with dengue and thrombocytopenia: a multicentre, open-label, randomised, superiority trial [published online March 7, 2017]. Lancet. doi:10.1016/S0140-6736(17)30269-6
2. Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature. 2013;496:504-507. doi:10.1038/nature12060
3. Suaya JA, Shepard DS, Siqueira JB, et al. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg. 2009;80:846-855.
4. Lum LC, Abdel-Latif Mel A, Goh AY, Chan PW, Lam SK. Preventive transfusion in dengue shock syndrome—is it necessary? J Pediatr. 2003;143: 682-684. doi:10.1067/S0022-3476(03)00503-1
5. Khan Assir MZ, Kamran U, Ahmad HI, et al. Effectiveness of platelet transfusion in dengue fever: a randomized controlled trial. Transfus Med Hemother. 2013;40(5):362-368. doi:10.1159/000354837