A 25-year-old traveller returns from Southeast Asia with 5 days of high fever, severe headache, retro-orbital pain, and a positive NS1 antigen test. On day 5, his platelet count falls to 28,000/µL. He develops warning signs: persistent vomiting and abdominal tenderness. What is the most important management principle at this stage?

• A Prophylactic platelet transfusion immediately to maintain count > 50,000/µL
• B Hospitalisation with close monitoring; IV crystalloid fluid therapy guided by clinical parameters ✓
• C Oral aspirin for fever and pain relief
• D IV methylprednisolone to reduce vascular leak

Explanation

Dengue with warning signs requires hospitalisation and IV fluid resuscitation guided by haematocrit and clinical status (urine output, vital signs) to manage plasma leakage. WHO dengue guidelines advise against prophylactic platelet transfusion unless there is active significant bleeding with thrombocytopenia; platelet transfusion does not prevent haemorrhage and may worsen fluid overload. Aspirin is contraindicated in dengue (increases bleeding risk and causes Reye's syndrome). Corticosteroids have not been shown to reduce dengue severity.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.