The rampant rise of dengue cases in strife-torn Manipur since January 2023 has triggered an alarming fear of another outbreak among the general masses in the state.
Dengue cases in the state have skyrocketed in the last two-three months amid the conflict, putting tremendous strain on the health care sector of Manipur particularly on the Transfusion Medicine department of several medical institutes.
Medical institutions, both government and private, are reeling under immense pressure to keep up with the staggering demand for platelets transfusion which has skyrocketed with severe dengue cases rising overnight.
“We are definitely feeling the pressure, so much so that it is overwhelming. The demand for platelets ever since the rise of dengue cases in the state is beyond our expectations,” said (in-charge) of the JNIMS Blood Centre Dr Surjit Konsam Medical officer.
He stated that the centre had been reeling under immense pressure to keep up with the urgent platelet demand. The flare up in dengue cases has doubled the platelet requirement quota, he added.
"Earlier, platelet transfusion was mostly done for blood cancer patients. Therefore, the centre kept a routine-requirement amount for cancer patients. With the increase in demand, the centre now faces acute shortages of platelets,” he said.
He noted that JNIMS only had a facility for formulating Random Donor Platelet (RDP) which only produced around 5-10 thousand platelet counts per donor.
“There are cases when patients with severe dengue illness require 5-6 units of platelets. In such cases we advise the families to opt for Single Donor Platelets (SDP) to avoid risk of multiple donor exposure and Transfusion Transmissible Infections (TTI),” he said.
However, he also informed that there were no Aspheresis machines for SDP in JNIMS at present.
He noted that dengue patients with platelets count below 20,000 are the ones which require urgent transfusion.
He added that the risk of bleeding and other health complications are high in such cases.
“There are cases where a dengue patient's platelet count is low but well above the critical level; they may demand platelet transfusion but in such cases we give them counseling and offer them alternative treatment methods,” he said.
He highlighted that the blood centre gave out platelets transfusion, one or two units short of the recommended unit to cope with the increasing demand.
“Usually, we wait for the 96 sample slots of the ELISA testing kits but now we test whatever sample amount we have and waste few testing kits so that we are able to produce platelets swiftly,” he added.
He maintained that around 10 patients per day, sometimes even more, had been coming in for platelet transfusion since the last few months.
Meanwhile, JNIMS medical superintendent Dr Kh Lokeshor informed that JNIMS had admitted a total of 146 dengue patients since July 2023, of which only 26 required platelet transfusion. No deaths have been reported so far.
He stated that there were currently around 10 active dengue patients at JNIMS.
“Definitely, there is a shortage of platelets at JNIMS but it is not absolutely absent. The most important issue at the moment is to tackle the apprehension of the masses and not trigger panic,” he said.
He informed that not all dengue cases required platelet transfusion except a few as such alternative methods are recommended in such cases.
There is no specific treatment for dengue unless there are complications; therefore, only symptomatic and supportive treatment is provided, he added. He said that there are four types of Dengue - DENV 1, 2, 3 and 4.
“Most of the dengue cases at JNIMS are dengue fever and few are intermediate patients,” he informed. He further stated that the dengue outbreak is mostly focused in urban areas and advised people to keep a clean and hygienic surrounding to stop mosquito breeding.
He further claimed that the dengue outbreak in Manipur was endemic in nature and stated that mass awareness should be the utmost priority at the moment to avoid an uncontrolled outbreak.
Meanwhile, head of Transfusion Medicine, RIMS Dr K Rajchandra and former HOD professor A Barindra Sharma informed that RIMS was also feeling the heat of the dengue outbreak which has substantially increased in the last few months.
“Around 30-40 platelets units are used everyday with 15-25 daily dengue patients since the start of September. This includes patients from other institutions as well. The whole issue kicked off around August but the demand has tremendously climbed since September,” said Dr Rajchandra.
He stated that the transfusion had been struggling to cope with the demand and had resorted to certain strategies to meet the demand of all dengue patients who urgently require transfusion.
“We cut down 1 or 2 platelet units recommended by the doctor so that we are able to keep the supply running for all severe dengue patients. We have also increased the intake of donors which at the moment is very low,” he said.
He maintained that RIMS will be purchasing Aspheresis machine for SDP within the next 15-20 days to increase the output of platelets. Platelets can be stored for a period of 5 days, he said. With this machine the donor criteria will be more specific, he added.
He emphasised the need for increased blood donations and awareness among clinicians.
Clinicians need to be more aware when recommending platelet transfusion because at the moment they are writing out the transfusion even for mild dengue patients, he added.
He exhorted people to come out more and donate blood to aid the health workers in tackling the platelet shortage.
“The situation is alarming but it will subside once winter sets in as mosquito behavior changes,” he added.
Consultant of Transfusion Medicine, Shija Blood Centre Dr Chongtham Rajmani stated that the issue of platelet shortage was not that pertinent at Shija hospital. He pointed out that 4-5 dengue patients were admitted to Shija hospital on a daily basis since the outbreak gained traction.
“Severe dengue cases are far and few. On top of that, we have the Aspheresis machine for SDP which enables us to cope with the platelet demand,” he said.
He stated that the cost was a little bit higher compared to RDP to do a whole procedure but risks in RDP procedures are non-existent in SDP.
He mentioned that Shija Blood centre was ticking all the boxes to make sure the supply demand line ran smoothly.
SDP is a platelet transfusion method in which platelets are prepared from a single donor by an apheresis machine. RDP is a platelet transfusion method in which platelets are prepared by centrifuging the whole blood collected from four to five donors and pooling the platelets. So, this is the key difference between SDP and RDP.
The state reported 1,204 cases of dengue till October 9, 2023.
State Malaria officer Dr S Priyokumar while speaking to another media outlet had also stated that fogging and source detection drives had been conducted at several locations across the state to stop mosquito breeding apart from holding awareness programmes to prevent Dengue infections.