Potential danger of isolated platelet transfusion in patients with dengue infection

The explosive release of pro-inflammatory cytokines in patients with dengue virus infection has cascading effects on endothelial cells lining blood vessels so that the endothelial lining resembles a ‘war zone’1. The activated endothelium is sticky; dysfunctional endothelium may be leaky. These transient endothelial phenomena (battle scars) are more pronounced in patients with dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) compared to those with uncomplicated dengue fever. The sticky activated endothelium causes platelets to adhere to it, thus decreasing the number of platelets free-floating in circulation and possibly is a major mechanism of thrombocytopenia in dengue infection. Reduced organ perfusion as platelets sticking onto the endothelium occlude its microvasculature may contribute to organ (system) failure and death. Capillary leak seen in dengue virus infection is likely to be a consequence of endothelial dysfunction, as the integrity of the vessel wall barrier is affected.