My sister is admitted in ICU for the past two days due to a heavy loss in platelet count after dengue. Her organs got affected and she is under a ventilator. Single donor platelet transfusion, plasma, and blood with an antibiotic have been given for the past two days. I want medical advice and please suggest about the treatment.
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I am sorry to hear about the illness. I have checked the attached reports (attachment removed to protect patient identity). There is a positive finding in the report. There is high SGPT (alanine transaminase), high SGOT (aspartate transaminase), high bilirubin, fragmented RBC (red blood cells), high neutrophils, low platelets, low HB (hemoglobin), high total count, high urea, and creatinine. So she is having dengue hemolytic anemia with infection and multiorgan dysfunction.
To combat the infection, antibiotics are given and a single donor platelet is given to raise the platelet count. Treatment is given in the right direction as per history. But her liver and kidney are badly deteriorated and therefore the prognosis is poor. Her viral monitoring should be done regularly and supportive treatment in the form of intravenous fluid and Ryle tube feeding should be given properly. Her condition is not good and the treatment is proper. I hope she will recover from the illness soon.
Thank you doctor,
Yes, there is an increase in the platelet count. But still, there is bleeding. I thought that blood clots can occur when there are sufficient platelets. Do antibiotics help in this condition? We are worried about the continuous bleeding.
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I am worried about hemolytic anemia. She is having dengue hemorrhagic fever with hemolysis of blood. Constant bleeding occurs due to hemolysis of red blood cells. Hemolysis means the destruction of red blood cells. Antibiotics help to fight against infection and it can be given. Sickle cells are also seen. So she might have sickle cell anemia along with hemoglobinopathy as her hemoglobin was low along with hemolysis. Therefore sickle cell anemia has contributed to additional hemolysis of red blood cells.
According to history, blood transfusion and fluid management should be done and close monitoring of vitals should be done. A platelet count of 73000 is not normal and the normal range should be above 1.5 lakhs. In hemolytic anemia, due to DIC (disseminated intravascular coagulation), platelet count goes down even if the platelet count was normal previously. Due to the hemolysis of RBC (red blood cells) and deterioration of the liver and kidney, the prognosis is not good. Plasma, platelet, and blood transfusion are the main form of management as of now. I pray for her recovery.
Thank you doctor,
I am once again looking for your inputs to evaluate the patient's health condition. Her platelet count has got increased from 73000 to 1.3 lakhs and her hemoglobin is 8.8 g/dL. Her blood pressure and urine culture are normal. Her ventilator dependency has got reduced to 94 % from 100 %. There is an improvement in her liver function and the bleeding is sporadic. With this observed improvement, can we assume that the body has started responding to its own blood contents or it is due to continuous blood transfusion? Please suggest.
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If there is an improvement in the liver function and urine output, then the condition is getting improved and the body is trying to recover. Ventilator dependency has got improved and so her body is improving. But still, she should recover more. Her hemoglobin and platelet can be got improved due to transfusion. I hope that her liver and kidney parameters will improve more and so she can recover soon.
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