Not all dengue patients need mega-platelets: official

Sindh Blood Transfusion Authority secretary advises mega-platelets use only in extreme cases

KARACHI:

People in general and doctors in particular have been advised against unnecessary transfusion of mega platelets for dengue patients.

Sindh Blood Transfusion Authority (SBTA) Secretary Dr Durenaz Jamal has stated that it is not necessary to administer mega-platelets to dengue patients.

Talking to The Express Tribune she said even individuals with reduced platelet counts can be adequately treated using normal platelets. Medical experts should refrain from recommending mega-platelets for every dengue patient.

Dr Durenaz Jamal also mentioned that due to the increase in dengue cases, SBTA has mobilised all blood banks. Blood banks have been instructed to store platelets and prevent their wastage. Platelets can be stored for only four to five days at a specific temperature. Mega-unit platelets are only administered when a dengue or malaria patient has platelet counts drop below 20,000, and there is a risk of further bleeding.

Both mega-unit and regular platelets have similar effectiveness. A bag of mega-unit platelets costs around Rs46,000, while random donor units are available for Rs28,000. The fundamental difference lies in the fact that mega-unit platelets are prepared from a single individual's platelets, whereas random donor platelets require contributions from 5 to 7 individuals.

One mega-unit is equivalent to 5 to 7 units of random donor platelets. Random donor units have the capability to increase platelet counts by 10,000, while mega-unit platelets can raise counts by 50,000 to 70,000.

Several blood banks in Karachi, including Husaini Blood Bank, Aga Khan Blood Bank, Liaquat National Blood Bank, Ziauddin Blood Bank, Jinnah, and South Hospitals, possess apheresis machines. These machines are used to prepare mega-unit platelets, but their cartridges are relatively expensive, selling in the market for 30,000 to 34,000 rupees. These cartridges cannot be reused after a single application.

Pakistan is one of the countries where blood donations are relatively low. However, mega-platelets are not the sole solution to dengue. Last year, when dengue cases surged, many doctors were compelled to arrange for mega-platelets for patients. Doctors should educate the public that if platelet transfusion is recommended, random donor platelets can also be used.

Mega-platelets are not necessary. In the past, cases were seen where patients had platelet counts exceeding 20,000, but doctors still insisted on mega-platelets for them. An individual should ideally have around 120,000 platelets. In cases where people receive unnecessary platelet transfusions due to the negligence and lack of seriousness among citizens, it can lead to blood clotting within their bodies.

When doctors are treating a patient, they understand the sensitivity of the matter and perform CBC tests daily based on the patient's condition. In such situations, when fear spreads among the public, opportunistic individuals benefit. Those involved in the illegal trade of substandard platelets should face legal action. Citizens should consult with medical experts before opting for mega-platelet transfusions because the dengue virus typically subsides in about 11 days, allowing the body to regenerate platelets naturally.

Regarding this matter, Dr. Natasha Ali, an expert in hematology at Aga Khan University Hospital, mentioned that not every dengue patient requires mega-platelets. If a patient's platelet count drops below 10,000, and they are continuously bleeding internally or externally, then mega-platelet transfusion may be recommended. In most cases, the quality of platelets from random donors does not impact the patient. In such cases, doctors are compelled to recommend mega-platelets when a patient's condition is particularly critical.

Dr. Zeeshan Hussain, a hematologist at Hamdard Hospital, stated that 6 to 7 mini-unit platelets are considered equivalent to 1 mega-unit platelet. Studies do not conclusively prove that mega-platelets are always necessary. The objective is to replenish the platelet deficiency in the patient's body. Whether 6 mini-units are administered or a single mega-unit, the effect is essentially the same.

Published in The Express Tribune, September 2^nd, 2023.