Dengue infection: How does dengue impact your blood platelet count? Does every patient require transfusion?

How does dengue impact your blood platelet count?

With the surging rise in the number of dengue cases amidst unseasonal rains, there's now a need for extra preventive care and awareness about dengue. While dengue fever remains a disease best beaten with preventive practices, it's also important that people pay attention to timely recovery, and avoid complications- one of them being a sudden drop in platelet count.

Loss of platelets is one dreaded complication amongst dengue patients, and can impact recovery. While one battles the infection, many also require transfusions and how stable the platelet and blood count level is determines how healthy one may be. But how does a dengue virus so profoundly impact vital cells and cause platelets to drop? Is every case of low platelet count worrisome in dengue cases? We try to explain:

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What role do platelet counts play in vital functioning?

Platelets are colourless, small fragments present in the bloodstream which help support important functions like hemostasis, thrombosis, infection and wound healing. They are primarily produced through the bone marrow, and help to prevent, stop and control clotting. Therefore, when the platelet count is low, or drops, the body cannot form clots (cannot stop or manage an infection spreading) and even lead to bleeding. While platelet loss can have a lot of underlying causes, the symptoms can lead to excessive bleeding, vital organ damage and other fatal symptoms, if not managed in time.

How does dengue impact your platelet count?

The dengue infection primarily spreads through the bite of a virus-infected aedes aegypti mosquito. When the mosquito bites you, the virus enters your body and starts to spread. The drop in platelets is caused by a condition referred to as 'thrombocytopenia', which happens either via direct bone marrow suppression or by means of an autoimmune reaction and antibodies pushed into place. Thus, while the dengue virus in itself doesn't destroy the platelets, it can unleash complications which harm platelet function and count.

Remember, the basic dengue spreads is by entering the bloodstream, attaching itself to the platelets and leading to replication. When this happens, the 'infected' platelets tend to cause damage to the healthy platelets as well, and are further aggravated by the body's immune defence attacking them, mistaking them to be foreign bodies. When the bone marrow function is suppressed as well, it can also lead to a staggering drop in the counts, and cause problems.

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How fast can platelets drop?

While loss of platelets can be registered to a number of underlying conditions, on average, it is assumed that healthy individuals have somewhere around 150,000–450,000 platelets/μL, and when they are infected by the dengue virus, the platelet count can reach as low as <40000 platelets/μL (10-15% of patients can also observe platelet count go beyond the 20,000 mark). In some cases, the drop can be witnessed within a day's time. This usually happens during the peak of infection, 3-4 days of fever. The platelet loss can also be aggravated by existing comorbidities, immunity, age.

What are the signs to observe your platelet count is dropping?

Now, while platelets play a critical and crucial role in healing and recovery, low platelet counts could turn your infection into a severe one, and lead to significant issues. While dengue patients are asked to get routine tests, one of the ways platelet loss can be observed is through signs of bleeding. Thrombocytopenia can lead to easy or excessive bleeding, superficial bleeding (which can show up as rashes and scabs on the skin), blood in the urine, fatigue. With dengue, in cases where the platelet count goes beyond the 10,000/uL mark, it can also cause spontaneous bleeding, which is deemed as a life-threatening risk.

If your platelet counts are low, how can it impact your healing?

As mentioned above, platelets play a very important role in healing and recovery. When the platelet count are diminishing, and the bone marrow is also in a compromised state to be unable to produce good volumes of platelets, it can ultimately slow down recovery, increasing the risks of complications. However, at the same time, it's also important to remember that the rate of loss, and when, and how a patient would need to rely on transfusion depends on the risk of age and comorbid conditions. Less than 10% of dengue patients (those who may also face the risk of severe dengue) may require critical hospitalization, acute transfusion, while the other patients tend to recover well on their own, and the platelet count increases over time.

What can you do to increase platelet count in the body?

Platelet counts can be raised with the help of regular transfusions, in cases where it is required. Apart from such therapies, one of the best ways to spike up platelet count is by including recovery aiding foods in your diet. Including papaya leaf extract, green leafy veggies, fruits, iron-rich foods, vitamin-C and vitamin-K rich foods and supplements are some of the ways to increase and stabilize healthy platelet count during the infection stage.

Gene therapy for blood disorder may be effective

Gene therapy for patients with a severe form of the blood disorder beta-thalassaemia could be safe and effective as well as end the need for transfusions, results from the clinical trials show.


Beta-thalassaemia is a genetic disorder that impairs the body's ability to produce a key component of haemoglobin — a critical protein in red blood cells that carries oxygen to organs and tissue.

People with the most severe forms of beta-thalassaemia require monthly blood transfusions, right from their toddler age, to replenish their red blood cell supplies along with iron chelation to remove extra iron from the body.

Frequent transfusions, however, can cause serious complications due to iron toxicity and viral infections.

The results showed that a one-time treatment with the gene therapy known as LentiGlobin BB305 vector reduced or eliminated the need for blood transfusions in 22 patients with severe beta-thalassaemia.

 We saw remarkable outcomes using LentiGlobin gene therapy, with most patients no longer needing monthly transfusions, said lead author .

 'These study results exceeded our expectations with clinical benefit for nearly all patients and suggest that gene therapy may be an effective treatment for thalassaemia in the future, he added.

Of the 22 patients aged between 12 and 35 years, 15 patients achieved transfusion-free status, while others needed transfusions less often.

All the patient underwent chemotherapy, after which they were infused with their own stem cells that were treated in the lab with a modified virus to replace the gene that is defective in thalassaemia. Patients typically reached peak production of haemoglobin in 9-12 months after infusion.

'While these gene therapy trials were the largest for thalassaemia to date, we need to evaluate effectiveness in a much larger population, the author said, adding that they 'are now enrolling patients as young as five-years-old on a Phase 3 trial.

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Scientists transform donor blood to make it safe for all

The NHS has welcomed the research at British Columbia University in Vancouver, Canada, but said clinical trials were needed. Millions of hospital patients are set to benefit from a new medical breakthrough which turns all donated blood into a universal type. Every day, thousands of people need donated blood. But only blood without A or B antigens, such as type O, can be given to people in need. Type O blood is usually in short supply because less than one in two people have it and stocks are used up quickly. Now scientists have made a major leap forward in making all blood universal. According to research in the Journal of the American Chemical Society, doctors have discovered an efficient way to transform A and B blood into a neutral type that can be given to any patient. Currently, blood transfusions require that the blood type of the donor match that of the recipient. If they are not the same, a patient can suffer serious side effects and even die. The exception is the universal-donor blood type O, which can be given to anyone because it doesn’t have the A or B antigens that could provoke an immune reaction. Up to now scientists have been searching for a way to convert types A and B into type O. In new experiments, Dr Stephen Withers and a team from the University of British Columbia in Vancouver, Canada, found that some enzymes from bacteria can clip the sugars off red blood cells that give blood its “type.” But the enzymes are not very efficient. So the research team set out to see if they could boost the activity of the enzymes. The researchers tweaked one of those enzymes and improved its ability to remove type-determining sugars by 170-fold, rendering it antigen-neutral and more likely to be accepted by patients regardless of their blood type. In addition to blood transfusions, the researchers say their advance could potentially allow organ and tissue transplants from donors that would otherwise be mismatched. In the UK only 36 per cent of adults have blood group O+ (positive) and 11 per cent have O- (negative). However, only four per cent of Britons are blood donors. According to latest figures, one in four people in Britain will need a blood donation at least once in their lifetime and 1.65 million units of donated blood, each of 470 millilitres, are issued to hospitals a year. Nick Watkins, assistant director of research and development at the NHS Blood and Transplant service, said: “We welcome new developments that have the potential to improve transfusion practice. The concept of creating universal donor cells by chemical/enzymatic treatment is not new and clinical trials will be required before such a product could be used in patients. There remains a need for volunteer blood donors of all blood types for the foreseeable future." THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES. PS- THOSE INTERESTED IN RECIPES ARE FREE TO VIEW MY BLOG- HTTP:GSEASYRECIPES.BLOGSPOT.COM       FOR INFO ABOUT KNEE REPLACEMENT, YOU CAN VIEW MY BLOG- HTTP://KNEE REPLACEMENT-STICK CLUB.BLOGSPOT.COM/ FOR CROCHET DESIGNS HTTP://MY CROCHET CREATIONS.BLOGSPOT.COM

ALL YOU WANT TO KNOW ABOUT DENGUE

Here's an FAQ on all that you need to know about dengue fever.  What is dengue fever? Dengue infection is caused by a virus. It occurs commonly as dengue fever. Occasionally the patient suffering from dengue may develop bleeding. Common sites for bleeding are nose, gums or skin. Sometimes, the patient may have coffee ground vomiting or black stools. This indicates bleeding in gastro intestinal tracts and it is serious. The patient with dengue who has bleeding has dengue haemorrhagic fever (DHF). Rarely the patient suffering from dengue may develop shock, then it is called dengue shock syndrome (DSS). When should I suspect dengue?Dengue should be suspected when you have sudden onset of fever. The fever is high 103-105 degrees F or 39-40 degrees C. It is accompanied with severe headache (mostly in the forehead), pain behind the eyes, body aches and pains, rash on the skin and nausea or vomiting. The fever lasts for 5-7 days. In some patients, fever comes down on 3rd or 4th day but comes back. All the above symptoms and signs may not be present in the patient. The patient feels much discomfort after the illness. There are several types of fever, when should dengue be suspected? The characteristics of dengue that make it different from other causes of fever are the pain behind the eyes, severe pains in the muscles, severe joint pains, and skin rashes. These features make the diagnosis of suspected Dengue likely. The severe joint pains caused by DF are the reason why DF is also called break-bone fever. What is the difference between suspected and probable case of dengue? If a patient suspected to be having dengue has reduced platelets or an increase in blood haematocrit, then the patient has probable dengue. These additional findings make dengue more likely. Patients with dengue may not have a high haematocrit if the person was anaemic to start with. (Platelets are cells in blood that help to stop bleeding. Haematocrit indicates the thickness of blood). Can you get dengue again after suffering from it once? It is possible to get dengue more than once. Dengue can occur because of 4 different but related strains of dengue virus. If a person has suffered from one virus, there can be a repeat occurrence of dengue if a different strain is involved subsequently. Being affected by one strain offers no protection against the others. A person could suffer from dengue more than once in her/his lifetime. Can the diagnosis of dengue be confirmed?There are laboratory tests that provide direct or indirect evidence for dengue fever. These tests provide evidence for the occurrence of dengue infection. There are some additional tests that can help to identify the type of dengue infection. The tests for confirmation of dengue should be done in reliable laboratories. How can someone get dengue fever? Dengue fever occurs following the bite of an infected mosquito Aedes aegypti. This type of mosquito has a peculiar white spotted body and legs and is easy to recognise even by laymen.  It breeds in clean water and has a flight range of only 100-200 metres. The mosquito gets the dengue virus after biting a human being infected with dengue virus. Can someone get dengue fever from another person? Dengue does not spread directly from person to person. It is only spread through the bite of an infected mosquito. When does dengue develop after getting the infection? After the entry of the virus in the person, it multiplies in the lymph glands in the body. The symptoms develop when the virus has multiplied in sufficient numbers to cause the symptoms. This happens generally about 4-6 days (average) after getting infected with the virus. Can people suffer from dengue and not appear ill? Yes. There are many people who are infected with the virus and do not suffer from any signs or symptoms of the disease. For every patient with symptoms and signs there may be 4-5 persons with no symptoms or with very mild symptoms. Can dengue fever be treated at home?Most patients with dengue fever can be treated at home. They should take rest, drink plenty of fluids that are available at home and eat nutritious diet. Whenever available, Oral Rehydration Salt/ORS (commonly used in treating diarrhoea) is preferable. Sufficient fluid intake is very important and becomes more important in case DF progresses into DHF or DSS where loss of body fluid / blood is the most salient feature. It is important to look for danger signs and contact the doctor as soon as any one or more of these are found. What is the treatment? Is it curable? Like most viral diseases there is no specific cure for dengue fever. Antibiotics do not help. Paracetamol (can be purchased without prescription) is the drug of choice to bring down fever and joint pain. Other medicines such as Aspirin and Brufenshould be avoided since they can increase the risk of bleeding. Doctors should be very careful when prescribing medicines. Any medicines that decrease platelets should be avoided. Can dengue fever become dangerous?The infection can become dangerous since it may cause damage to the blood vessels. The damage may range from increased permeability of the blood vessels, causing leakage of blood fluid/plasma into various organs to completely broken blood vessels that causes bleeding. The symptoms and signs of dengue haemorrhagic fever and dengue shock syndrome are related to damage to the blood vessels and derangement in functioning in components of blood that help it to clot. Can people die from dengue fever?People who suffer from dengue fever have no risk of death but some of them develop Dengue Haemorrhagic Fever or Dengue Shock Syndrome. In some of these cases death can occur. With proper treatment, the patients with Dengue haemorrhagic fever and dengue shock syndrome can recover fully. Good treatment provided in time can save most lives When should a patient suffering from dengue go to the hospital or consult a doctor?Generally the progress towards dengue haemorrhagic fever or dengue shock syndrome occurs after 3-5 days of fever. At this time, fever has often come down. This may mislead many of us to believe that the patient is heading towards recovery. In fact, this is the most dangerous period that requires high vigilance from care-givers. The signs and symptoms that should be looked for are severe pain in the abdomen, persistent vomiting, bleeding from any site like, bleeding in the skin appearing as small red or purplish spots, nose bleed, bleeding from gums, passage of black stools like coal tar. Bring the patient to the hospital whenever the first two signs, namely, severe pain in the abdomen and persistent vomiting are  detected. Usually it is too late if we wait until bleeding has occurred. The most dangerous type of dengue is the dengue shock syndrome. It is recognised by signs like excessive thirst, pale and cold skin (due to very low blood pressure), restlessness and a feeling of weakness  Is there a vaccine to prevent dengue fever? A vaccine has been developed to prevent dengue fever, but it is still under trial. It is not yet available in the market. Scientific progress is likely to help in prevention of dengue fever by vaccination in the years to come. Are there any long-term ill effects of dengue fever?Most people who suffer from dengue fever recover in 1-2 weeks time. Some may feel tired for several weeks. However, if symptoms persist after this period, consult a doctor. Where does the mosquito that spreads dengue live?The highly domestic mosquito Aedes aegypti rests indoors, in closets and other dark places. Outside, it rests where it is cool and shaded. The female mosquito lays her eggs in water containers in and around the homes, and other dwellings. These eggs will develop, become larvae, and further develop into adults in about 10 days. How can the multiplication of mosquitoes be reduced?Dengue mosquitoes breed in stored, exposed water collections. Favoured places for breeding are barrels, drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles, tins, tyres, water coolers etc. To prevent the mosquitoes from multiplying, drain out the water from desert coolers/window air coolers (when not in use), tanks, barrels, drums, buckets etc. Remove all objects containing water (e.g. plant saucers etc.) from the house. Collect and destroy discarded containers in which water collects e.g. bottles, plastic bags, tins, used tyres etc. In case it is not possible to drain out various water collections or to fully cover them, use TEMEPHOS, an insecticide, ( brand name Abate) 1 part per million according to the local guidelines to prevent larvae from developing into adults How can I prevent mosquito bites to prevent dengue? There is no way to tell if a mosquito is carrying the dengue virus. Therefore, people must protect themselves from all mosquito bites. Dengue mosquitoes bite during the daytime. Highest biting intensity is about 2 hours after sunrise and before sunset. Wear full sleeves clothes and long dresses to cover as much of your body as possible. Use repellents -- be careful in using them in young children and old people. Use mosquito coils and electric vapour mats during the daytime also to prevent dengue. Use mosquito nets to protect children, old people and others who may rest during the day. The effectiveness of these nets can be improved by treating them with permethrin (pyrethroid insecticide). This bed-net is called Insecticide Treated Nets and are widely used in the prevention of malaria. Is there any advice for the patient with dengue fever to prevent the spread of the disease to others? The spread of dengue from a patient to others is possible. The patient should be protected from contact with the mosquito. This can be achieved by ensuring that the patient sleeps under a bed-net. Effective mosquito repellents are used where the patient is being provided care. This will prevent the mosquito from biting the patient and from getting infected and spreading it to others. Anyadvice on travel if there is an outbreak of dengue?There is no travel restriction. However, you should be aware of what to do if you are travelling an area where dengue has been reported. This includes observing prevention measures described in these frequently asked questions and answers and reporting to the doctor if you have fever and are worried that it might be dengue fever. What should the doctors treating dengue do?Patients suspected to be suffering from dengue haemorrhagic fever or dengue shock syndrome should be admitted to a hospital without delay. The progress of these patients should be monitored regularly at 1-2 hours interval. Platelet counts and haematocrits should be monitored repeatedly to review the progress of patients. f the haematocrit levels fall dangerously then a blood transfusion should be considered. A fall of more than 20 per cent as compared to previous levels may be an indication for transfusion. If the haematocrit values rise the patient should be given fluids intravenously and the fluids carefully monitored to ensure that the patient does not get excess fluids. A rise of more than 20 per cent as compared to previous levels may be an indication for IV fluids. The doctor should decide based on best judgement of patient's condition. What should the doctors treating dengue NOT do?Do not prescribe aspirin and brufen or any other medicine that reduces the platelets or increases the tendency to bleed. Avoid giving IV fluids unless the patient is bleeding or the haematocrit level is rising progressively. Avoid rushing into giving blood transfusion unless the haematocrit is falling dangerously. Do not give platelet transfusion unless the platelet count is very low or unless there is bleeding. In the case of a dengue outbreak or epidemic what should be the strategies? Prevention of mosquito breeding places should remain as mainstay. However, to stop or to slow down the transmission it may be supplemented by "thermal fogging", using fogging machines. In fogging, one can use an insecticide that has an immediate knockdown effect on adult mosquitoes. When fogging is undertaken after an epidemic occurs, it is unfortunately too late. Fogging, to be effective, should be done at about 3-4 days interval. It is expensive and time consuming. Therefore, measures undertaken by the community, for the community, to prevent the breeding  of mosquitoes is far more cost-effective than containment measures once an outbreak occurs.