Prospective observational study of low thresholds for platelet transfusion in adult dengue patients
Laurent Thomas
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorStéphane Kaidomar
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorBrigitte Kerob-Bauchet
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorVictor Moravie
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorYannick Brouste
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorJean Philippe King
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorSarah Schmitt
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorFrançois Besnier
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorSylvie Abel
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorHossein Mehdaoui
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorYves Plumelle
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorFatiha Najioullah
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorChristiane Fonteau
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorPascale Richard
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorRaymond Césaire
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorAndré Cabié
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorLaurent Thomas
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorStéphane Kaidomar
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorBrigitte Kerob-Bauchet
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorVictor Moravie
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorYannick Brouste
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorJean Philippe King
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorSarah Schmitt
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorFrançois Besnier
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorSylvie Abel
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorHossein Mehdaoui
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorYves Plumelle
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorFatiha Najioullah
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorChristiane Fonteau
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorPascale Richard
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorRaymond Césaire
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorAndré Cabié
From the Centre Hospitalier Universitaire de Fort-de-France, Martinique (FWI); Etablissement Français du Sang de la Martinique; and Centre d'Investigation Clinique et d'Epidémiologie Clinique Antilles-Guyane (CIC-EC 802 INSERM).
Search for more papers by this authorThis study was supported by the Centre Hospitalier Universitaire de Fort-de-France, Martinique.
Presented in abstract forms at the Second International Conference on Dengue and Dengue Haemorrhagic Fever, Phuket, Thailand, October 15-17, 2008; and at the 8ème Congrès National d'Hémovigilance et de Sécurité Transfusionnelle, Perpignan, France, November 19-21, 2008.
Abstract
BACKGROUND: The practice of platelet (PLT) transfusions has been adopted into the standard clinical practice in many dengue-endemic countries. Because many patients were found to have received unnecessary PLT transfusions, the development of guidelines for the management of dengue patients with thrombocytopenia has become a necessity.
STUDY DESIGN AND METHODS: An emergency department–based prospective observational study was conducted in Martinique during a dengue outbreak in adult patients presenting with an acute febrile illness. Patients with severe bleeding and/or who underwent invasive intensive care procedures or emergency surgery were given PLT transfusion to achieve PLT counts of more than 50 × 109/L. PLT transfusion was also considered for patients with PLT counts of less than 5 × 109/L and for those with associated risk factors and PLT counts of less than 20 × 109/L.
RESULTS: A total of 350 patients were admitted with confirmed dengue infections. Most of them had secondary serotype-2 infections. PLT counts of less than 50 × 109/L were recorded in 165 patients (47.1%). PLT transfusion was administered to 9 patients with thrombocytopenia. The indications included severe bleeding (5 cases), invasive procedures (3 cases), emergency surgery (1 case), and/or associated risk factors (2 cases). The median time duration from the onset of fever to PLT transfusion was 6 days (range, 4-10 days). The median amount of PLTs transfused was 3.66 × 1011 (range, 2.8 × 1011-13.2 × 1011). The median PLT yield was +12.4% (range, −3.9% to +67.1%). Three patients died. All other patients recovered during the second week after the onset of fever.
CONCLUSION: A restrictive strategy for PLT transfusion based on clinical features and low PLT count thresholds proved to be feasible and safe for adult dengue patients.
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