New delhi:
Department of Internal Medicine along with Department of Haematology , Sir Ganga Ram Hospital has conducted a study to validate the usefulness of a New Test for accessing need of blood transfusion during Dengue ; called Immature Platelet Fraction (IPF) . Sir Ganga Ram Hospital was the first hospital in Delhi to use IPF test on Dengue patients during 2015 .
According to Dr Atul Kakar , Senior Consultant and Vice Chairman, Department of Internal Medicine, Sir Ganga Ram Hospital “ IPF is an important parameter to predict platelet recovery and helps avoid platelet transfusion . It not only helps in reducing cost of blood transfusion but also helps avoid transfusion related complications .
According to Dr. Jyoti Kotwal , Chairman, Department of Haematology , Sir Ganga Ram Hospital , “Immature platelets are recently released young platelets from bone marrow of Dengue patients . We found that range of normal IPF at SGRH using 100 normal individuals is 0 to 7.25 % . Thus if IPF is more than 7.25 % , it signals presence of younger re-generating platelets and once IPF crosses 10 % , it signals that decreased platelet count will increase in next few hours . “
The study was done on 50 adult patients of confirmed Dengue fever having platelet count less than 100000/cumm who were admitted at Sir Ganga Ram Hospital in 2015 . Platelet is one of the major component of blood that is affected in Dengue fever and whose normal value is 1.5 to 4.5 lakhs . In this study, relationship of reduced platelet count with immature platelet fraction was evaluated on a daily basis.
40 patients had Dengue without alarm signs, 9 patients had Dengue with alarm signs and 1 patient was classified as having severe dengue. Decreased platelet counts leads to bleeding in dengue fever. In our study bleeding was reported in 18% (9/50) of patients.
All patients with bleeding received platelet transfusion. The transfusion of blood and blood products are not always safe. The major risks associated with transfusion of platelets include fever, allergy, blood and blood products induced lung injury and infection. Hence transfusion should be considered only in those patients in whom it is necessary.
According to existing guidelines, Platelet transfusion is indicated when platelet count is less than 20000/cumm or if the patient has bleeding. Thus in our study the indications of transfusion were present in 18 patients. However only 12 patients out of 18 ( 66.66%) received appropriate transfusion. In 6 of the 18 (33%) patients rplatelet transfusion was deferred as their immature platelet fraction values were high. Thus IPF helped prevent platelet transfusion in 1/3 rd patients who would have otherwise received a platelet transfusion.
To conclude: This is the first clinical study in which we have found test called Immature platelet fraction as a useful test. Immature platelet fraction can be taken as an indicator of Bone marrow recovery from insult caused by Dengue Virus. Immature platelet fraction values can be taken as an indicator of requirement platelet transfusion. The same can be deferred if immature platelet fraction values are high, patient is not bleeding and patient’s blood pressure is stable. We can also prevent transfusion related complications in this scenario.
This study was done in Sir Ganga Ram Hospital by Dr. Darshit Shah ( DNB resident, Department of Internal Medicine ) under the guidance of Dr. Atul Kakar ( Senior Consultant and Vice Chairman, Department of Internal Medicine) and Dr. Jyoti Kotwal ( Chairperson , Department of Haematology )
Finding the utility of IPF in reducing the need for platelet transfusion in large number of Dengue positive patients , Department of Internal Medicine & Department of Haematology at Sir Ganga Ram Hospital is using IPF to monitor platelets with Dengue during the current season also