Platelet Count, D-Dimer, Component Therapy and Dengue Hemorrhagic Fever

Excerpt

Dear Editor, Sridhar et al. reported an interesting finding on “Correlation of the Platelet Count with D-Dimer Levels as an Indicator for Component Therapy in Children with Dengue Hemorrhagic Fever (DHF)” [1]. Sridhar et al. concluded that “DHF children with thrombocytopenia and features of shock, aggressive component therapy may prevent subsequent bleeding and may be justified [1].” In fact, the standard management of DHF with or without shock is fluid replacement therapy with closed monitoring [2]. The role of using component therapy is controversial. In the present report, there are many considerations. First, using seropositive as a selection criterion for inclusion might not successfully exclude many similar tropical diseases that can have cross reactive with dengue. Second, there is no evaluation on the effectiveness and clinical utility of using component therapy. Third, in any DHF cases with or without shock, D-dimer can be increased [3]. There is also no proof that having transfusion therapy for DHF with shock results in better clinical outcome than standard fluid replacement therapy [2]. In case that transfusion therapy is selected, the reason is usually severe bleeding presentation but not shock [4]. …