Prevention and treatment of thrombocytopenia in dengue patients: a narrative review

Abstract

Background and Aims: Dengue fever is a major health concern, especially in developed countries, because it often leads to undifferentiated febrile illness such as dengue haemorrhagic fever and dengue shock syndrome or expanded dengue syndrome, which are often reported with thrombocytopenia (TCP) and turn out to be hazardous to life. The WHO reported 23 million dengue cases and 82,000 deaths between 1955-2012. 2019 was a hallmark for the dengue epidemic from Latin America to South Asia. Due to unavailability of a dengue vaccine and antiviral therapies, additional medical attention and effort are required to treat thrombocytopenia (TCP). These approaches include thrombopoietin receptor agonists such as Oprelvekin, Eltrombopag, Romiplostim and corticosteroids, and platelet transfusion and intravenous immunoglobulin transfusions. The outcomes might not be achievable unless the proper assessment is carried out to evaluate these approaches to treat TCP in dengue patients. This narrative review aims to summarize the findings regarding the treatment of TCP in patients affected by the dengue virus. Methods: A total of 55 published articles, including clinical trials, descriptive studies and case studies were reviewed regarding treatment of TCP in the context of dengue infection. The electronic databases PubMed, Cochrane Library, Google Scholar and Science Direct were searched for articles published from January 1990 to June 2020. Conclusions: We concluded that dengue fever is becoming a global health concern. Premedical attention like the use of corticosteroids, Thrombopoietin receptor agonist (TPO-R) agonists and transfusions like (PT & IVIG) are not fully assessed by double-blind randomized clinical trials and cost-effectiveness analysis. However, as compared to other treatment approaches, the use of TPO-R agonists seems to be more suitable in TCP management due to its easy access and compliance.