The scary platelet countdown

As Dengue spreads its tentacles far and wide, patients are caught in a twister of dropping blood platelet counts.

The drop in Ranji’s platelet count was sharp, dramatic and near-fatal. Frantic, his friends and relatives sent out messages all around as doctors readied the transfusion machine.

In that eleventh hour, they knew his life depended on that urgent dose of fresh blood. Dengue had taken a menacing turn. Yet again!

Monsoon might be on its last legs, but Bengalureans are still caught in a twister of Dengue and Dengue-like diseases.

Thousands are hospitalised, their fluctuating platelet counts triggering confusion, fear, anxiety, and despair! Trying out a mix of allopathy, ayurveda and natural remedies, they are in a collective frenzy to find a way out.

Low platelet count leads to bleeding and complications that could eventually prove fatal. Rules mandate platelet transfusion if the count slips below 10,000 per micro litre of blood. That is way too less than the normal count of 1.5 lakh to 4 lakh.

Costly affair
But transfusion is a costly affair. The more effective Single Donor Platelets (SDR) costs a minimum of Rs. 11,000 per unit, a price fixed by non-commercial blood banks based on Karnataka State Aids Prevention Society (KSAPS) guidelines. In corporate hospitals, the price is much higher.

However, despite the high costs, there has been a big spike in transfusions over the last three months. At the Rotary TTK Blood Bank, a whopping 940 SDP units were sent for transfusion. The numbers hovered around 750 in August and 650 in September. The trend is similar in blood banks across the City.

Greater awareness of Dengue and its symptoms have apparently reduced the fatality rate. But more data has sparked another trend: Guided by internet search, patients themselves pushing doctors to prescribe transfusion, even when the count is way above 10,000. 

Transfusion does raise the count. But it is clearly not a simple, last-minute process, as Dr Darshan Padulkar, consultant, transfusion medicine, TTK Blood Bank, points out. “When the count is below 20,000, and the patient is not bleeding, you should start looking for donors. You cannot predict by how much it will fall.”

Donors should first clear all the mandatory tests related to HIV, Hepatitis B and C, malaria and syphilis. They should not be diabetic on insulin.

Neither should be taking any anti-biotics or aspirin. Their BP level should be under control, hemoglobin levels below 12.5g/dL and weight above 55kg. Importantly, their own platelet count should be 1.5 lakh or more.

Dangerous donation
First degree relatives (father, mother, brother, sister) should not donate. Dr Darshan warns of the risk of contracting the fatal Transfusion Associated Graph Versus Forced Disease (TAGVHD). “This is 100 per cent fatal. Desperate for blood, donors sometimes don’t say they are related. This can be dangerous,” warns Dr Darshan.

The Drug and Cosmetic Act, 1945 has stipulated that the concentrates should contain a minimum of 3X1011 platelets per unit. Once extracted, they can be stored for five days at 22 degrees Celsius in continuous agitation. Blood bank doctors assure that during transportation in the specified blood bags, the count does not come down.

For those who cannot afford the cost of transfusion or hospitalization, precaution against Dengue is a critical necessity. But it is a tricky affair, since mosquitoes that transmit the virus breed even on clean water if stored in the open.

As Dr Triveni from the Institute of Public Health explains, there is a clear lack of awareness on what causes the disease to spread, even among the educated.
“They talk about garbage being a cause. It is actually stagnant water. Since water supply is irregular in many parts, people tend to store them in the open, attracting the mosquitoes,” she says.

But when it rains, even open containers such as cups and tyres in uncleared garbage collect water and turn breeding grounds. BBMP health department officials are obviously responsible for clearing these sites. However, as Dr Darshan says, that responsibility rests on citizens too. They could start with their houses.

Virulent form
If proper care is not taken, the danger of contracting a more virulent form of the disease called the Dengue Hemorrhagic Fever (DHF) gets real. The drop in platelet count is drastic in DHF.

Doctors say the count can go down to 2,000 levels quickly. Transfusion then becomes the only option.

Random Donor Platelet (RDP), priced at about Rs 750 a unit might look cheaper. But doctors say these platelets, sourced from multiple donors are vastly inferior to SDP in count.

Six RDP units would be required to equal the platelet count of one SDP unit. Besides, there is the risk associated with mixing blood from several donors.

So, is there a way out for those who cannot afford the high price? Blood banks say they often send free platelets to government hospitals.

On paper, patients could expect subsidised transfusions at these healthcare centres. But the huge demand for the blood component puts a question mark on their ability to cater to the rising numbers.