Unnecessary platelet transfusions raise concern

Staff Correspondent: As the dengue outbreak is worsening across Bangladesh, especially in Dhaka, the demand for platelets has surged at an unusual rate.
The situation is posing serious challenges for hospitals and blood banks to meet the increasing demand for platelets.
Terming the demand unusual, medical experts said many dengue patients are given platelets unnecessarily due to fear. In 80-90% of cases, platelets are used unnecessarily, they added.
The number of dengue patients is increasing rapidly across the country. Bangladesh on Tuesday registered yet another 16 deaths from the mosquito-borne disease, raising the toll to 201 this year.
A total of 7,927 dengue patients, including 4,646 in the capital, are now receiving treatment at hospitals across the country.
The 50th death was recorded on July 1, followed by the 100th one on July 15 with the 150th one coming on July 20 – then it took just five days for the 200th dengue fatality to be confirmed.
It has been found that most of those who died of dengue were women.
According to the Directorate General of Health Services (DGHS), one of the leading causes of death from dengue is late hospitalization – most patients die within a few days of hospitalization.
According to doctors, not only dengue, if there is an infection in the blood, or if there is a fever, the amount of platelets decreases.
People think that platelets are needed for treatment only in the case of dengue. But they termed the idea wrong.
However, with the increase in dengue patients at an alarming rate, many have expressed concern as the demand for platelets increases.
Some people think that doctors transfuse platelets in many cases to keep themselves safe.
Global guidelines say if the number of platelets in the blood is 10,000, a transfusion can be considered.
Talking to various blood banks in the capital, this correspondent came to know that the demand for platelets has increased several times over the last few weeks.
On an average, 200 to 250 people look for platelets every day, they said, adding that other times this demand is 40 to 50 bags.
Mizan, an official at a blood bank and transfusion centre located on the capital’s Green Road, said: “We are very worried about the demand for platelets. Such demand is not seen at any other time. Doctors’ notes show the platelet count – 70,000 to 80,000. Still, platelets are being taken. We cannot forbid them, because the doctor knows better whether the patient can be given platelets.”
When is platelet transfusion necessary?
Dr Ashraful Haque, a blood transfusion expert and assistant professor at Sheikh Hasina National Institute of Burn and Plastic Surgery, considers the current demand for platelets to be unusual.
“The demand we get here is two-three times more than usual. The demand here is mainly for cancer patients. We try to look at requisitions at various times to see why doctors suggest transfusing platelets. Now it is being found that the dengue patients with 80,000-90,000 platelet count are also suggested to transfuse platelets.”
He also said: “The use of platelets in treatment seems to have increased due to fear. Doctors may be afraid of worsening the patient’s condition, so they give it earlier. Unnecessary use has increased due to fear of treatment. In 80-90% of cases, platelets are being used unnecessarily.”
When asked who needs platelets, he said: “Platelets will decrease in a dengue patient – this is very normal. Due to dengue, the normal production process of platelets in our body decreases. Again, even if the production is good, sometimes the breakdown is more than the production. If there is an infection or fever in our body, even if it is not dengue, platelets decrease. In cases where the platelets are very low and bleeding, that is when the patient really needs platelets.”
Dr Ashraful Haque said: “In many cases, the platelet count is 80,000, but there is bleeding. Sometimes the count is 5,000, but the patient is fine. It is not just that platelets are low, but platelets have a lot to do with the blood-clotting process. That is why there is bleeding.”
For this, global guidelines say platelets can be given if the count is 10,000. But the matter depends on the physical condition of the patient, said the expert.
He also said that a patient’s treatment may be prolonged due to the use of unnecessary platelets.
Professor Dr ABM Khurshid Alam, directorate general of the health directorate, cautioned against doing business taking advantage of dengue patients through the unusual use of platelets in the treatment.
He said the protocol developed for the treatment of dengue clearly states when to give platelets and when not.