CMO: We need to save platelets for those who need them

CHIEF Medical Officer Dr Roshan Parasram said platelets should only be given to patients who are clinically determined to need them.

Speaking at a media conference at the Health Ministry, Queen’s Park East, on July 19, Parasram said there are specific clinical indications for the use of platelets when it comes to dengue.

In a news release on July 20, the ministry said there have been four dengue-related deaths and 392 laboratory-confirmed cases for 2024.

Parasram said, “Platelets are a product that are a part of and are produced out of blood. Clinical use should be guided by a haematologist at the regional health authority level. We’re asking senior physicians to determine the patients who actually need it. We really want to reserve it for the ones who really need it.

“The cases who really need it, in layman’s terms, are the ones who have severe dengue, severe disease, with very low platelet counts – I wouldn’t define the limits – with bleeding going forward as well. You have to have active bleeding with very low platelet levels arising out of dengue.”

He said there were two mechanisms by which platelet counts drop in dengue.

“There’s the suppression of your bone marrow to produce platelets on your own, which is one reason why you get the drop.
"The virus also destroys the platelets in circulation. It’s called a platelet consumption disease. If we add platelets to a situation like that, the likelihood is that in severe dengue, the platelets added will also be destroyed, so it doesn’t help a great lot.

"It’s reserved for certain clinical scenarios as determined by a haematologist or senior medical physician as to when it should be used.”

Health Minister Terrence Deyalsingh said there is a misconception that every dengue patient needs platelets or blood.

“It is unfortunate the way the conversation is being carried (on). Every single patient does not need blood, does not need platelets.

"When I was hospitalised for dengue, I spent two nights in Port of Spain (General Hospital). My platelets dropped, but it rebounded.

“We have the capacity in this country to generate platelets.

"But I have also been asking the country to become voluntary blood donors for a couple of years, and not to wait for a crisis. People tend to respond to emergencies. We are not proactive.”

He said when the Non-remunerated Voluntary Blood Donation system was launched on June 14, 2022, he challenged the country to stop the chit system.

“Let’s give blood freely so when someone is in a crisis and already traumatised, they and their family don’t need the additional stress of trying to get blood.”

Parasram joined with the minister in calling for more voluntary blood donation.

“We’re making a clarion call to the public to continue donating as much blood as possible so our general supply will improve. Blood is a natural resource and the more of it we have through voluntary means especially, the better off we’ll be as a country in terms of supply.”

Parasram said platelets are the part of blood which allow clotting, while white blood cells fight off  infection. He said it was best to wait until after the severe phase of the disease had passed before administering platelets, to ensure they were not destroyed.

The officials disputed relatives claims about the issue of platelets in a Newsday article titled Debe actor with dengue needs blood platelets on July 17.

Parasram said the ministry had checked on the patient but declined to comment further, as he would be responding to an individual.