20% of new dengue cases showing severe drop in platelet count: Doctors

Pune: About 20% of newly diagnosed dengue patients are reporting a severe drop in platelet count within 24 hours of symptoms' onset, leading to liver derangement in most cases, treating doctors told TOI on Friday.

"The platelet count in such patients is dropping below 70,000 within 24 hours. But not every one of them needs hospitalization," said Dr Santaji Kadam, a family physician practising in the Kothrud area.

"Liver tests, including SGPT and SGOT (enzymes produced by the liver and its cells), show elevated counts, indicating liver derangement in most such cases. These patients complain of abdominal pain, nausea, vomiting and severe weakness within 24 hours of the symptom onset. Not all, but about 5% of them require hospitalization. Identifying these patients early helps in fast recovery, with appropriate treatment," Dr Kadam said.

Rampant incidence of elevated sugars (a pre-diabetic condition) and fatty liver in young adults could be among the reasons why most diagnosed with dengue show severe symptoms, the doctors said.

"Platelet count usually starts dropping during the critical phase. And it is around this time that patients and their family members start pressurizing doctors for administering platelet transfusion," said Ruby Hall Clinic's chief intensivist Dr Kapil Zirpe.

Most people with dengue recover within a few days. But in some cases, symptoms worsen. This is called severe dengue, which happens when blood vessels become damaged and leaky. And the number of clot-forming cells (platelets) in the bloodstream drops, leading to shock and internal bleeding. "Platelet transfusion in the absence of bleeding does not prevent bleeding," Dr Zirpe said.

Internal medicine expert Dr Abhijit Lodha said, "One of the reasons for people seeking hospital care is low platelet count. They insist on it, even when there are no other warning signs."

Deenanath Mangeshkar hospital's critical care expert Dr Prasad Rajhans said, "Platelet transfusion in absence of bleeding in adult dengue patients does not reduce chances of bleeding."