In Dengue haemorrhagic fever, plasma leakage and thrombocytopaenia result partly from antibody-dependent enhancement (ADE). Platelet activation and endothelial damage by dengue also involve NS1 protein. At which platelet count threshold does the WHO recommend therapeutic platelet transfusion in stable DHF?

• A <50,000/μL in all DHF patients
• B <20,000/μL with or without bleeding, or <50,000/μL with active significant bleeding
• C <100,000/μL as soon as diagnosis confirmed
• D Prophylactic transfusion is not recommended; transfuse only for severe spontaneous bleeding ✓

Explanation

Current WHO and clinical guidelines for dengue do NOT recommend prophylactic platelet transfusion for a specific platelet count threshold in the absence of significant bleeding in stable DHF. Platelet transfusions have not been shown to reduce bleeding risk and may worsen plasma leakage. The primary treatment is judicious IV fluid resuscitation to replace plasma leakage. Platelet transfusion is reserved for severe, life-threatening bleeding (e.g., massive GI bleed, intracranial haemorrhage). Daily platelet count monitoring guides fluid management decisions.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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