Assessment of the importance of platelet transfusion in patients with severe dengue: a systematic review
Evaluación de la importancia de la transfusión de plaquetas en pacientes con dengue grave: una revisión sistemática
Jorge C.F. Nakazaki, Angela I. Cotera-Ramón
Abstract
Introduction: Dengue is one of the most important vector-borne viral diseases in subtropical and tropical regions. The World Health Organization (WHO) 2009 classified dengue into three groups: dengue without alarm signs, dengue with alarm signs, and severe dengue. According to the type of dengue, various managements have been proposed. The authors suggest that a predictive factor to avoid a poor prognosis in this disease is to keep platelet levels stable in the patient to prevent a fatal outcome. The aim of this paper is to analyze the efficacy of transfusion of platelet agents in the outcome of patients with severe dengue and thrombocytopenia.
Material and methods: A bibliographic search was carried out in the Medline, OVID, and Scielo databases from January 1, 2008, to April 31, 2023, using the MeSH terms.
Results: 7 articles were included in the systematic review. A wide range in age was found (18 to 79 years). A minimal number of studies detail the comorbidities of patients in their enrollment. Regarding platelet transfusion, the average number of platelet units used in the transfusion case was 5 (2 - 14). Transfusions of ABO identical and compatible pooled platelets transfusion were found to be more successful in increasing platelets. Almost all of the patients included in the studies had platelets <20,000 at enrollment. One study found a significant increase in platelets after transfusion, while the rest did not find it compelling. No mortality associated with platelet transfusion was recorded.
Conclusions: Prophylactic platelet transfusion is not recommended as a routine measure in patients with severe dengue and thrombocytopenia. The uncertainty highlights need to reach a specific consensus establishing the appropriate indications for platelet transfusion and what type of patients with dengue virus would be beneficial.
Keywords
Resumen
Introducción: El dengue es una de las enfermedades virales transmitidas por vectores más importantes en las regiones tropicales y subtropicales. La Organización Mundial de la Salud (OMS) en 2009 clasificó el dengue en tres grupos: dengue sin signos de alarma, dengue con signos de alarma y dengue grave. Según el tipo de dengue se han propuesto diversos manejos. Los autores sugieren que un factor predictivo para evitar un mal pronóstico en esta enfermedad es mantener estables los niveles de plaquetas en el paciente para evitar un desenlace fatal. El objetivo de este trabajo es analizar la eficacia de la transfusión de plaquetas en la evolución de pacientes con dengue grave y trombocitopenia.
Material y métodos: Se realizó una búsqueda bibliográfica en las bases de datos Medline, OVID y Scielo desde el 1 de enero de 2008 al 31 de abril de 2023, utilizando los términos MeSH.
Resultados: Se incluyeron 7 artículos en la revisión sistemática. Se encontró un amplio rango de edad (18 a 79 años). Un número mínimo de estudios detallan las comorbilidades de los pacientes en su inscripción. En cuanto a la transfusión de plaquetas, el promedio de unidades de plaquetas utilizadas en el caso de transfusión fue de 5 (2 - 14). Se encontró que las transfusiones de plaquetas combinadas ABO idénticas y compatibles tuvieron más éxito en el aumento de plaquetas. Casi todos los pacientes incluidos en los estudios tenían plaquetas <20 000 en el momento del reclutamiento. Un estudio encontró un aumento significativo de plaquetas después de la transfusión, mientras que el resto no lo encontró convincente. No se registró mortalidad asociada con la transfusión de plaquetas.
Conclusiones: La transfusión profiláctica de plaquetas no se recomienda como medida de rutina en pacientes con dengue grave y trombocitopenia. La incertidumbre pone de relieve la necesidad de llegar a un consenso específico que establezca las indicaciones adecuadas para la transfusión de plaquetas y qué tipo de pacientes con el virus del dengue serían beneficiosas.
Palabras clave
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Submitted date:
12/30/2023
Reviewed date:
01/30/2024
Accepted date:
02/22/2024
Publication date:
03/07/2024
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