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64 ■ February 2016 11
editorial
considered risky in patients with predict severity of illness, need for interrelationship between virus and the
thrombotic thrombocytopenic transfusion and outcome. imbalance between coagulation and
fibrinolysis and inflammatory mediators. vol
purpura because it can exacerbate It is indeed a very good attempt 2015 article ID 313842, 16 pages http://dx.doi.
microvascular thrombosis. 17 to develop a scoring system as it org/10.1155/2015/313842.
Drugs, malignancy, autoimmune can not only guide the clinician 6. Ganesan N, Gunasekharan I, Padhi S. Platelet
phagocytosis in peripheral blood during
conditions, associated liver but also help avoid unnecessary
acute phase of dengue virus infection. J Curr
dysfunction also need to be ruled out transfusions with all the associated Res Sci Med 2015; 1:51-53.
as they can cause thrombocytopenia. risks and burdening the blood 7. World Health Organization and Tropical
Supply of platelets is always banks. However as the authors Diseases Research Dengue:guidelines for
limited hence guidelines are also point out, there are several diagnosis,treatment,prevention and control.
limitations of this study. Geneva:world health organization;2009 new
necessary to guide the clinician edition.
about their judicious use. 1. The study is retrospective. 8. Lye DC,Lee VJ,Sun Y et al. Lack of efficacy of
Recent guidelines for 2. T h e c a u s e o f f e b r i l e prophylactic platelet transfusion for severe
thrombocytopenia in adults with acute
m a n a g e m e n t o f t r o p i c a l f e ve r 2 thrombocytopenia is not taken
uncomplicated dengue infection. Clin Inf Dis
suggest that in patients of fever into account. Many diseases 2009; 48:1262-5.
with thrombocytopenia one should like dengue and malaria do not 9. J a d h a v U M , Pa t k a r V S , K a d a m N N .
avoid aspirin and anticoagulants, require platelet transfusions if Thrombocytopenia in malaria-correlation
watch for bleeding and consider it there is no overt bleeding even with severity and type of malaria. J Assoc
Physicians India 2004; 52:615-618.
if platelet count is less than 20,000 when the counts are very low.
or there is clinical bleeding with 10. De Mast Q, Groof E, Lenting PJ et al.
3. The patient number is small and Thrombocytopenia and release of activated
specific therapy of infection once the study is done over a short von Willebrand factor during early malaria. J
diagnosis is established. duration. Inf Dis 2007; 196:622-628.
Immature platelet fraction (IPF%) Hence it is not possible to draw 11. WHO Guidelines for the Treatment of Malaria,
is an automated modern parameter second edition. Geneva, World Health
definite conclusions about the Organization (2010). http://www.who.int/
that measures young reticulated utility of the score from this study. malaria/publications/atoz/9789241547925/
platelets in the peripheral blood. However the score can be definitely enindex.html
I P F l e ve l s r i s e a s t h e m a r r o w validated by further larger studies. 12. Thiagarajan P,Afshar kharghan V,Platelet
production of platelets increases. 18 transfusion therapy. Hematol Oncol Clin N Am
For validation of risk score a 2013; 27:629-643.
It has been evaluated in Dengue
prospective study also looking
patients and found to be useful 13. Guidelines for the use of platelet transfusions.
into the causes of febrile Br J Haematol 2003; 122:10-23.
to predict recovery of platelets. 19
thrombocytopenia and associated 14. Slichter SJ.Evidence based platelet transfusion
An IPF value of more than 10.0%
comorbidities with appropriate guidelines. Haematology Am Soc Hematol Educ
indicates recovery of platelet count Programme 2007; 172-8.
sample size will be helpful for
within 48 hours. It appears to be a 15. Perrota PL, Snyder EL. Non infectious
drawing practical conclusions.
promising and reliable parameter to complications of transfusion therapy. Blood
guide decisions regarding platelet References Rev 2001; 15:69-83.
transfusions. 16. Heddle NM. Pathophysiology of febrile non
1. Abrahamsen SK, Haugen CN, Rupali P, hemolytic transfusion reactions. Curr Opin
In the present issue of the Journal, Mathai D, Langeland N, Eide GE, et al. Fever Hematol 1999; 6:420-6.
Kshirsagar, et al 18 have attempted in the tropics: Aetiology and case-fatality-A 17. Swisher KK, Terreli DR, Vesely SK, et al. Clinical
to develop a risk score for febrile prospective observational study in a tertiary outcomes after platelet transfusions in
thrombocytopenia so that an early care hospital in South India. BMC Infect Dis patients with thrombotic thrombocytopenic
2013; 13:355. purpura. Transfusion 2009; 49:873-87.
warning score can help decide
2. Singhi S,Chaudhary D,Varghese GM et al. 18. Briggs C, Kunka S, Hart D, Oguni S, Machin SJ.
regarding therapeutic intervention
Tropical fever management guidelines. Indian Assessment of an immature platelet fraction
like platelet transfusion. Journal of Critical care Medicine 2014; 18:62-69. (IPF) in peripheral thrombocytopenia. British
T h e a u t h o r s h a ve d e v i s e d a 3. Agarwal M, Rodgers GM. Miscellaneous causes Journal of Haematology 2004; 126: 93–99.
risk score based on platelet count, of thrombocytopenia in Wintrobe’s Clinical 19. Dadu T, Sehgal K, Joshi M, Khodaiji S.
vital signs and organ system Hematology 13th edition eds. Greer JP, Arber Evaluation of the immature platelet fraction
DA, Glader B, et al (2014)1097-1105. as an indicator of platelet recovery in dengue
involvement. Based on these patients. International Journal of Laboratory
parameters, the patients have been 4. National guidelines for clinical management Hematology.
of Dengue fever,National vector borne control
divided into low, moderate and programme 2015 nvdcp.gov.in/Doc/dengue 20. Kshirsagar P, Chauhan S, Samel D. Towards
severe risk category and the data national guidelines 2014 developing a scoring system for febrile
has been retrospectively analysed thrombocytopenia. J Assoc Physicians India
5. A zeredo EL, M onteiro R Q, Pinto 2016; 63:14-18.
to find if the total risk score could LM. Thrombocytopenia in dengue: