DENGUE- THE PLATELET MANIA

        DENGUE- THE PLATELET MANIA

I am giving a break to my regular series but this is important. Of course, there is increase in the cases of Dengue Fever in Delhi, but DO NOT PANIC.

Dengue is not fatal except in few conditions, which is also true for all other fevers too. Every year, approximately at this time, September and October, since 2005, the time first dengue case was reported, have been entailed as platelet months of Delhi, because it has become the hot shot topic of discussion in every household.

Here, I am trying to bust out 10 Myths about Dengue.

Myth 1: As soon as platelets become less than 30,000, whose normal limit is 1.5 lakh to 4 lakh, go for the transfusion.

BUSTED: Totally untrue. There are WHO guidelines that until and unless there is any active bleeding like a nose bleeding or bleeding in stool or any other kind, DO NOT go for any prophylactic platlet transfusion.

Myth 2: Frequent Platelet count is investigation of choice.

BUSTED: Not at all. Since there is increase in Dengue cases the labs are flooded with blood samples, therefore manual reading of platelet count becomes very difficult; hence the reports are machine read, which generally have an error of 25,ooo to 30,000. The machine count in most of the cases is 25,000 to 30,000 less. Therefore reliability of such reports is questioned.

Myth 3: Apart from Platelet count and dengue test (NSI Antigen), others are useless investigation.

BUSTED: As I have already stated above about the platelet test and the machine error in the reports, it require no further elaboration. On other hand, NSI Antigen test is an indicatory test, not Diagnostic test. If NSI come negative we can’t rule out Dengue. Other Laboratory tests of choice in case of Dengue are as below:

Ig M: it is an antibody test. If it is positive, it means the patient is having the first attack of Dengue. [Again, it is an indicatory test].

Ig G: If positive, indicates, patient had Dengue in past. [There are 4 strains of dengue]. The patient have to be cautions in such a scenario as severity of symptom may appear, but still DO NOT PANIC, there are further more criteria to elicit the  prognosis of the disease.

SGOT, SGPT: These are liver enzymes which can elevate in case of Dengue where liver involvement starts, hence indicating severity of case.

Myth 4: Prognosis of Dengue depend upon Platelet counts.

BUSTED: Not at all. Until and unless there is any active bleeding, it doesn’t matter how much the platlets of the patient have fallen. The prognosis of the case depends upon how much your body have been hydrated. The cases of death being reported in Dengue cases are because of multiple organ failure which is triggered by, intravascular dehydration. It so happens, Dengue triggers the increase of IL2, IL6 and TNF (Tissue nacrosies factor) which increases the permeability of vessels leading to intravascular dehydration and subsequently organ damage. This is represented by extreme degree of exhaustion patient feel so weak; it seems as if nothing is left in the body. Immediately start the hydration procedure start giving patient fluid etc. Give 1 liter of fluid in first hour and then keep hydrating till the patient passes urine. If the body is hydrated, it will pass urine every 2-3 hrs in this case.

Myth 5: Patient with low platelet count requires hospital admission.

BUSTED: Not at all. Patient who can’t be orally administered fluid require hospital admission. The patient diagnosed with dengue, who complains of vomiting, abdominal pain, gastritis, tenderness. [Indicating organopathies] require immediate admission.

And so are the high risk people which include

·        Pregnant woman.

·        New Born Babies.

·    People already suffering from Kidney, heart and liver problems even before they had Dengue.

·        Elderly People.

Myth 6: Prophylactic Platelets administration helps in treating the cases of Dengue.

BUSTED: Not at all, but it could be harmful rather than being beneficial. It could increase probability of blood transfusion related infection like HIV, Hepatitis B, and C.

-         If the blood be donated by the family member, [who could also be under Dengue surveillance and whose symptoms developed later] it could lead to transfer of double Dengue strain in the patient.

-         Platelets refractionaries can happen [laymen meaning, when unnecessary platelets are administered in body, when the body doesn’t require it. If next year the same patient has dengue again, and this time genuinely required the platelet administration, there is a dip in platlet count, instead of increasing after the transfusion]. It doesn’t happen in all cases.

-         Body can have platelet Anaphylactic shock [again, doesn’t happen in all cases].

Hence until and unless there is active bleeding, don’t force your doctors for Prophylactic platelet administration.   

Myth 7: The juice of leaves of papaya will increase the platelet count.

BUSTED: It is still debatable, but there is no harm in administering it after all it is also a form of liquid.

-         Few Ayurveda doctors have advised taking Galoy Vatti.

-         Curcuma longa [Haldi] can be useful in such cases as Haldi have Anti-TNF [Tumor Nacrosies factor] which can help in prevention of Intravascular Dehydration.

-         Avoid onion, garlic and medicine like Disprine, Brufien, Combiflame, or any other pain killers as they can decrease platelet count.

Myth 8: Platelets should increase as soon as the fever comes down.

BUSTED: Platelets can still fall for 48 hours after the fever comes down and then they increase so don’t panic.

Myth 9: Dengue mosquito can bite anytime.

BUSTED: Dengue mosquito bites in morning and malaria causing mosquito at night.

Myth 10: Dengue with itching in body is a worst form of Dengue.

BUSTED: According to few experienced doctors according to their clinical practice it is the mild form of Dengue. Do not panic.

IMPORTANT TIPS FOR DOCTORS:

The two makers indicating Intra vascular dehydration

-         Increase in PCV (packed cell volume) up to 20%.

-         Decrease in pulse pressure [systolic Diastolic pressure i.e. 40mm of Hg]. [Therefore, check the blood pressure yourself and don’t miss the pulse pressure].

MORAL

Keep the sanity of your mind and fight Dengue back, Delhites.

 Together we can and we will.