RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE
SYNOPSIS
“ROLE OF PLATELET TRANSFUSION IN THE MANAGEMENT OF DENGUE PATIENTS IN A TERTIARY CARE HOSPITAL”
Name of the candidate : Dr. Gillian Ruth Britto
Guide : Dr. Hilda Fernandes
Course and Subject : M.D Pathology
DEPARTMENT OF PATHOLOGY
FATHER MULLER MEDICAL COLLEGE HOSPITAL
KANKANADY, MANGALORE – 575 002.
ANNEXURE -II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the Candidate and Address[in block letters] / Dr. GILLIAN RUTH BRITTO
M.D. PATHOLOGY
DEPARTMENT OF PATHOLOGY
FATHER MULLER MEDICAL COLLEGE
KANKANADY, MANGALORE 575 002.
2. / Name of the Institution / FATHER MULLER MEDICAL COLLEGE
KANKANADY, MANGALORE 575 002
3. / Course of study and subject / M.D. PATHOLOGY
4. / Date of admission to the course / 30-April-2010
3. / Course of study and subject / M.Sc. MLT( (MEDICAL LABORATORY TECHNOLOGY (Haematology & Blood Trasfusion)
4. / Date of admission to Course / 05-10-2009
5. / TITLE OF THE TOPIC:
“ROLE OF PLATELET TRANSFUSION IN THE MANAGEMENT OF DENGUE PATIENTS IN A TERTIARY CARE HOSPITAL”
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Dengue fever is the most important acute arboviral infection of humans caused by the bite of the ‘Aedes Aegypti’ mosquito.[1]
Occurs worldwide in nearly all tropical and subtropical countries. The incidence has increased dramatically over the last few decades all over the world. The worldwide incidence is estimated to be 50 to100million cases of dengue fever and over 500,000 cases of dengue haemorrhagic fever.[2] The South East Asian countries such as India, Indonesia and Thailand are at the highest risk of dengue fever / dengue haemorrhagic fever accounting for nearly half of the global risk.[3] The dengue epidemics in India are cyclical and are more frequent, expanding geographically into the rural areas and all forms of serotypes are circulating in the community.[4]
Severe bleeding is related to severe thrombocytopenia. Platelet transfusion is given in those patients who is either bleeding or having other haemorrhagic symptoms along with thrombocytopenia. While medical fraternity globally recognizes the role of platelet transfusion in the management of hospitalized dengue patients the exact indications and situations in which these are to be transfused may vary.[3]
The aim of the study is to show the relationship between thrombocytopenia and bleeding and to evaluate dengue patients as to when and whom to transfuse platelets.
6.2 REVIEW OF LITERATURE:
The dengue virus belongs to the family ‘ Flaviviridae’.[1] The risk of dengue has shown an increase in recent years due to rapid urbanization, lifestyle changes and deficient water management including improper water storage practices in urban, peri-urban and rural areas, leading to proliferation of mosquito breeding sites.[5]
Dengue patients are grouped into 3 categories:[2]
1. Dengue fever. 2. Dengue haemorrhagic fever. 3. Dengue shock syndrome.
1. Dengue fever is an acute febrile illness of 2-7 days duration (sometimes with two peaks) with two or more of the following manifestations:[2]
· Headache
· Retro-orbital pain
· Myalgia/ arthralgia
· Rash
· Haemorrhagic manifestation (petechiae and positive tourniquet test)
· Leukopenia
2. Dengue Haemorrhagic fever is a probable case of dengue and haemorrhagic tendency evidenced by one or more of the following:[2]
· Positive tourniquet test
· Petechiae, ecchymosis or purpura
· Bleeding from mucosa (mostly epistaxis or bleeding from gums), injection sites or other sites
· Haematemesis or melena
· Thrombocytopenia (platelets 100,000/cu.mm or less) and
· Evidence of plasma leakage due to increased capillary permeability manifested by one or more of the following:
o A>20% rise in haemotocrit for age and sex
o A>20% drop in haemotocrit following treatment with fluids as compared to baseline
o Signs of plasma leakage (pleural effusion, ascites or hypoproteinaemia).
3. Dengue Shock Syndrome (DSS) All the above criteria of DHF plus signs of circulatory failure manifested by rapid and weak pulse, narrow pulse pressure (< or equal to 20 mm Hg); hypotension for age, cold and clammy skin and restlessness.[2]
Haemorrhagic diathesis/ thrombocytopenia (decrease in the platelet count) is one of the key manifestations in dengue patients.[5] The etiology of thrombocytopenia in dengue infection is multi-factorial it may be bone marrow suppression, destruction of megakaryocytes and the formation of anti-platelet antibodies are the possible mechanisms postulated.[6] So platelet concentrate are transfused when the platelet count becomes less than 20,000/cu mm. In general prophylactic platelet transfusion may be given if platelet counts drops <10,000/cu mm in absence of bleeding manifestations.[5] In recent studies platelet transfusion are only given in dengue hemorrhagic patients with spontaneous bleeding and platelet counts <40,000/cu mm.[3]
All hospitalized dengue patients can be categorized into four categories based on their platelet count at the time of admission.[3]
1. High risk: The patients belonging to this group have platelet count <20,000/cu mm and they are at a high risk of bleeding. Such patients by the rule of the thumb should be receiving prophylactic platelet transfusion, the patients in this category whose platelet count <10,000/cu mm have even greater risk and need to be prioritized in case of an epidemic or in case of limited resources.
2. Moderate risk: All the patients whose platelet count is in between 21,000-40,000/cu mm belong to moderate risk category. The patients of this risk group should be transfused with platelet only if they have any hemorrhagic symptoms.
3. Low risk: Those patients whose platelet count >40,000/cu mm but <100,000/cu mm for the age and sex should be observed and monitored carefully but should not receive unnecessary platelet transfusion because of the risk of transmission of blood borne infection (with no benefit of platelet transfusion).
4. No risk category: Patients falling in this category usually have the platelet count > 100,000cu mm. They should never be transfused with platelet and be managed on intravenous fluids and supportive therapy.
6.3 OBJECTIVES OF THE STUDY:
1. To study the number of dengue patients requiring platelet transfusion.
2. To find out the response of the patients after platelet transfusion.
3. To evaluate the role of platelet count, a routine test as a marker for predicting outcome in dengue patients.
7. / MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
1. Two hundred serologically proven dengue patients will be enrolled in this study over a period of two years.
2. Clinical details will be obtained from the hospital information system, reports of haematological investigations, and blood bank records.
Inclusion criteria:
1. All the serologically positive dengue patients.
2. All age groups.
Exclusion criteria:
1. Co-existing malaria.
2. Other co-morbid conditions causing thrombocytopenia.
7.2 METHOD OF COLLECTION OF DATA :
Study type: Descriptive- Cross sectional study.
Sample and sampling technique:
1. Serum sample for IgM testing done by ELISA (Indirect method).
2.EDTA Blood sample for the platelet count by automated cell counter
Statistical Analysis: Collected data will be analysed by paired – t test and data will be presented in the form of frequency, percentage and by graph.
7.3 METHOD OF COLLECTION BLOOD :
The vitals of the patient are checked. The procedure is explained to him. The blood sample is collected under aseptic precautions.
7.4 Has ethical clearance been obtained from your institution in case of (7.3)?
- Yes
8. / LIST OF REFERENCES
1. World Health Organisation. Dengue Haemorrhagic Fever - diagnosis, treatment, prevention and control. 2nd ed ; Geneva, WHO, 1997; 1-84.
2. World Health Organisation. Guidelines for treatment of Dengue Fever/ Dengue Haemorrhagic Fever in Small Hospitals, Regional Office for South East Asia, New Delhi, WHO, 1999; 1-28.
3. Makroo RN, Raina V, Kumar P, Kanth RK. Role of platelet transfusion in the management of dengue patients in a tertiary care hospital. Asian J Transfus Sci 2007; 1(1): 4-6.
4. Ratageri Vinod H., Shepur T.A., Warsi P.K., et al. Clinical Profile and Outcome of Dengue Fever Cases. Indian J Pediatr 2005; 72(8): 705-706.
5. Directorate of National Vector Borne Diseases Control Programme, New Delhi. Guidelines for Clinical Management of Dengue Fever/ Dengue Haemorrhagic Fever and Dengue Shock Syndrome, 2008: 1-33.
6. Kabra SK, Jain Y, Madhulika, et al. Role of platelet transfusion in dengue haemorrhagic fever. Indian Pediatr 1998; 35(5): 452-455.
9. / SIGNATURE OF THE CANDIDATE:
10. / REMARK OF THE GUIDE:
11. / NAME AND DESIGNATION OF
(in block letters)
11.1 GUIDE / Dr. HILDA FERNANDES
ADDITIONAL PROFESSOR
DEPARTMENT OF PATHOLOGY
FATHER MULLER MEDICAL
COLLEGE, KANKANADY
MANGALORE – 575002
11.2 SIGNATURE
11.3 HEAD OF THE
DEPARTMENT / Dr. JAYAPRAKASH C.S.
ADDITIONAL PROFESSOR AND IN-CHARGE HOD
DEPARTMENT OF PATHOLOGY
FATHER MULLER MEDICAL COLLEGE, KANKANADY
MANGALORE - 575002
11.4 SIGNATURE
12. / 12.1 REMARKS OF THE
CHAIRMAN AND DEAN
12.2 SIGNATURE
Patient Identification Number for this trial:
Name :
Age : Sex :
OP.No : IP No :
CONSENT FORM FOR RESEARCH STUDY
Title of Project: “ROLE OF PLATELET TRANSFUSION IN THE MANAGEMENT OF DENGUE PATIENTS IN A TERTIARY CARE HOSPITAL”
Name of Researcher: Dr. GILLIAN RUTH BRITTO
Please tick to confirmI confirm that I have read and understood the information sheet for the above study / ð
I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily / ð
I understand that my participation is voluntary and that I am free to withdraw at any time, without giving any reason, without my medical care or legal rights being affected. / ð
I understand that relevant sections of any of my medical notes and data collected during the study may be looked at by responsible individuals from Father Muller Medical College, where it is relevant to my taking part in this research. I give permission for these individuals to have access to my records. / ð
I voluntarily agree to donate required blood and saliva for the above mentioned study / ð
I agree to take part in the above research study. / ð
Name of patient / Date / Signature
Researcher / Date / Signature
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