A 22-year-old woman has dengue fever confirmed by NS1 antigen. On day 5 she is afebrile, hemodynamically stable, has no mucosal bleeding, and her platelet count is 16,000 per cubic millimetre. According to standard guidance, when should prophylactic platelet transfusion be considered?

• A At any count below 50,000 per cubic millimetre
• B Prophylactic transfusion has no role at any platelet level
• C Only if there is active bleeding, irrespective of the count
• D When the count falls below 10,000 per cubic millimetre, even without bleeding ✓

Explanation

Prophylactic platelet transfusion in stable dengue patients is considered when the count drops below 10,000 per cubic millimetre, or below about 20,000 when additional risk factors such as uncontrolled fever, hypertension or peptic ulcer disease exist. Transfusing at 50,000 exposes the patient to unnecessary risks, and waiting strictly for active bleeding ignores the danger of spontaneous haemorrhage at very low counts, so both extremes are incorrect.

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

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Written and medically reviewed by the StethoPrep medical team.