Despite the issuance of the WHO Dengue Control Protocol for Pakistan and visits of Indonesian and Sri Lankan experts, the dengue diagnosis management and treatment remains a difficult task for doctors, Pakistan Today has learnt. A committee of professors set up by the Punjab government issued diagnostic guidelines for dengue fever, DHF and DSS, but they had not been implemented.
In principle, senior consultants in hospitals recommend platelet transfusion to patients but in practice senior doctors are absent from medical wards.
The Indonesian team of experts found flaws in the dengue treatment methodology in the country. According to them, once the platelet count of a patient was lower than 100,000, he/she should be hospitalised. But in practice, patients are not being admitted to some public hospitals unless they start bleeding or faint.
On the other hand, some doctors in public and private hospitals recommend platelet transfusion to dengue patients who have not started bleeding. Muhammad Sarwar, a dengue patient, who came to Lahore from Arifwala after his platelet count fell below 15,000, was denied admission in Service Hospital. He was admitted to CMH later, where doctors asked his attendants to arrange platelets for him, although he was not bleeding. Sarwar’s son said doctors asked him to arrange 6 to 7 platelet donors although mega platelet kits were available in the hospital. It should be noted that mega platelet units are available in Jinnah Hospital (JH), Children Hospital (CH), Sheikh Zayed Hospital (SZH), Inmol Hospital (IH), Combined Military Hospital (CMH) and the Pathology lab in King Edward Medical University (KEMU), which is at Mayo Hospital’s disposal. Patients from hospitals other than these have to go to the Institute of Blood Transfusion (IBT) for transfusion.
Atif, an attendant of a dengue patient in a private hospital, said doctors had asked him to arrange platelet kits his patient for the third time. He said the patient’s platelet count was 18,000 and he was not bleeding.
Muhammad Khan, a patient admitted in Data Darbar Hospital, said doctors prescribed him a transfusion by merely checking his platelet count.
Punjab Transfusion Services officials said more than 150 patients came to the mega platelet units every day. But for the past few days, the number of patients had decreased, they added.
Dr Javed Akram said platelets should be given only if major bleeding started. Major bleeding meant bleeding through genitals or internal bleeding, he added. Dr Akram said dengue fever made platelets bigger and stickier. He said qualitative analysis of platelets was also important in addition to their quantitative analysis. Akram said it was unethical to force patients’ attendants to arrange platelet kits despite their availability in hospitals. He said platelets transfused unnecessarily might kill the patients. Akram said there had been cases when patients expired due to unnecessary platelet transfusion. There were 6 cell separators available in JH’s platelet center and platelets could be arranged easily there.
KEMU Vice Chancellor Dr Asad Aslam said injecting platelets without complying with WHO’s guidelines was wrong. The practice might cause anaphylactic shock and might kill the patient, he added.
