According to the World Health Organization, the incidence of dengue has increased 30-fold in the past 50 years, and over half of the world’s population is at risk of infection. Acute infection with dengue virus typically causes flu-like symptoms, but can also be associated with severe bleeding and thrombocytopenia. In order to determine if prophylactic platelet transfusions decrease the risk of bleeding in dengue patients with thrombocytopenia, researchers randomly assigned 372 patients at 5 hospitals to receive either supportive care (bed rest, fluids, and general pain and fever-reducing medications) or supportive care and platelet transfusions (4 units of pooled platelets each day the platelet count was 20,000 µL or lower). Of the 181 patients included in the transfusion group, clinically significant bleeding occurred in 21%, compared to 26% in the control group receiving supportive care (relative risk, 0.81 [95% CI, 0.56 to 1.17]; p=0.16). In addition, adverse events were more likely to occur in the transfusion group compared to the supportive care group (p=0.0064). Prophylactic platelet transfusions, therefore, were not superior to supportive care for adult dengue patients with thrombocytopenia. Future research is needed to confirm the results of this trial in other populations, including children.
Lye DC, Archuleta S, Syed-Omar SF, Low JG, Oh HM, Wei Y, Fisher D, Ponnampalavanar SS, Wijaya L, Lee LK, Ooi EE, Kamarulzaman A, Lum LC, Tambyah PA, Leo YS. Prophylactic platelet transfusion plus supportive care versus supportive care alone in adults with dengue and thrombocytopenia: a multicentre, open-label, randomised, superiority trial. Lancet 201