Kishan Krupa, a 23-year-old engineer working in Bengaluru recalls the day he was admitted to a city hospital and diagnosed with dengue, as one of the scariest times of his life. While, according to doctors, a platelet count of 1.5 to 4.5 lakh per microlitre of blood is considered normal, a blood test showed that Krupa’s platelets had dipped to 40,000 after he got infected with the viral infection.
“I was getting panic attacks. A week before I was diagnosed with dengue, a friend of mine had died of dengue and another friend was admitted to the ICU in a serious condition. On day 1 of getting admitted, I was starting to feel breathless, and this sent me into a panic. I was very scared. I felt suffocated, and the fever was also at around 103 degrees Celsius,” Krupa tells Happiest Health. Krupa says the body ache he was experiencing was the biggest and the most painful symptom.
READ MORE :
Dengue: Treatment, Causes, Diagnosis, Treatment | Happiest Health
The dangers of paracetamol overuse
Chronic chikungunya: pain that ties down for months
Tackling typhoid with hand wash and vaccines
The boy who runs like the wind
This doctor broke the AIDS story before the US govt
Dr Riya Ballikar, consultant hematologist and haemato-oncologist, KIMS- Kingsway Hospital, Nagpur, says that most of the time when the body is battling an infection, a decline in platelets occurs. “This is especially true of viral infections,” she tells Happiest Health.
“Take dengue, which is a very common infection now,” she says, adding, “Normally, in case of dengue, the maximum decline in platelets occurs between the seventh day and the 14th day of the infection, or when the fever goes away. It would depend on the viral load and on how serious the disease is. In dengue, sometimes, even after one or two days of infection, the platelets will start dropping.”
Krupa says his platelet count fell within the first two days of getting admitted to the hospital.
He adds, “The doctor told me not to worry and that once the infection goes away, the platelet count will also go up spontaneously.”
Dr Ballikar says that a drop in platelets is sometimes associated with a lot of fatigue.
“The first two days were very difficult for me. I was feeling extremely weak,” Krupa admits.
Krupa also admits that he did not know much about the importance of platelets in the body before his platelet count witnessed a critical drop.
So what are platelets and what function do they serve in our bodies?
“Simply put,” Dr Ballikar explains, “Platelets are responsible for stopping bleeding [by causing clotting]. Whenever there is any injury in your body, these cells kind of form a mesh or a plug called a platelet plug. This prevents bleeding from happening.”
Explaining other functions of platelets, she says “They also have a role to play in infections as an anti-infective agent and [promote] some amount of tissue healing. Its most important function, however, continues to be the prevention of bleeding.”
Platelets and viral infections: What’s the link?
“We have blood cells which help in different functions of the body. There are three types of blood cells – white cells, red cells and platelets. All these cells are produced in the bone marrow. The bone marrow, in adults, basically is limited to the backbone. Because the virus affects a majority of the body’s cells, it also affects the cells which produce the platelets — the megakaryocytes. Because of the involvement of the platelet-producing cells, the platelet count comes down,” says Dr Kirti Sabnis, infectious diseases specialist, Fortis Hospital Mulund & Kalyan, Mumbai.
Dr Sabnis says that apart from the dysfunction of megakaryocytes, the destruction of platelets can also cause a dip in the platelet count.
Dr Ballikar explains how platelets get destroyed in the body. “Any infection in the body causes the production of something called antibodies. The normal function of these antibodies is to fight the infection or the virus. But during infections, these antibodies would normally start attacking the platelets. Secondly, the virus itself causes injury to the blood vessel – this is observed more in dengue.”
“Blood vessels are like pipes or tubes. Whenever there is an injury, there would be leakage from the pipes. In the process, the blood comes out and the platelets get trapped or destroyed,” Dr Ballikar adds.
Dr Sabnis says that although a falling platelet count is most commonly associated with dengue, several other viral infections including the Epstein–Barr viral infection, chicken pox and chikungunya can cause a drop in platelet count.
“Monkeypox, which we are now hearing about, can also cause a platelet decline. HIV infections can also cause this,” she says.
READ MORE
All you need to know about monkeypox – Happiest Health
What are the symptoms of a falling platelet count?
According to Dr Sabnis, some of the common symptoms of a low platelet count include:
- Small red spots (called petechiae) on the body
- Bleeding gums
- Bleeding while coughing and vomiting
- Bleeding from the nose
“Small red spots form on the body mainly in the areas of pressure. If the person is undergoing a blood test, for instance, and there is a tight band around their hand, red spots will form in this area,” says Dr Sabnis.
How to increase platelet count
Dr Ballikar says that the treatment would depend on the infection that is causing the drop in platelet count.
“For example, in the case of dengue, around 40 to 80 per cent of people infected will have a low platelet count. It is that common. If there is bleeding or if the platelet count is very low (less than 10,000 or 15,000), that’s when we give platelets externally. Other treatment methods would be symptomatic. For instance, if there is bleeding, we give something called an antifibrotic agent which will arrest the bleeding. We give supportive care – some viruses have drugs that are used in their treatment – such as HIV and hepatitis B,” she says.
Dr Ballikar adds that in cases where the platelet count is not critically low, once the viral infection is treated, the platelet count will also spontaneously improve.
“People who have a low platelet count of around 80,000 and have bleeding will need to get admitted. If they do not have any bleeding manifestations during acute viral infections, we generally don’t give platelet transfusion,” says Dr Sabnis.
Explaining how the process of platelet transfusion works, Dr Ballikar says it involves administering someone else’s platelets into the body of the person battling the viral infection.
“It’s like a normal saline IV. They [platelets] are collected in a bag from donors and given into the vein. One of the reasons why a drop in platelet count happens is the destruction of platelets. Hence, sometimes when you’re giving platelets from outside, there are chances of it getting destroyed. In that case, the increase would not be so much. But sometimes, the increase is significant and mostly, the increase is immediate,” she says.
Though the transfusion of platelets is similar to a blood transfusion, it’s not the same, as it cannot be donated directly like blood.
“In case of platelet transfusion, the platelets must be prepared. Someone must first donate blood. From this blood, we will separate different components such as plasma, red blood cells and platelets. To separate platelets from the donated blood, there is highly processed equipment that maintains all sterile precautions which are used in blood banks,” says Dr Sabnis.
The platelets are then stored in a blood bank. While donated blood can be stored for 20 to 21 days, platelets have to be used quickly and stored separately with more sterile precautions, Dr Sabnis says.
Krupa meanwhile relied on natural methods to bring his platelet count back to normal.
“The most important thing that the doctor recommended was going on a strict diet. I was asked to eat more papaya. I was consuming juice made from papaya leaves twice a day – once in the morning, once at night. The doctors said that this would increase the platelet count. After two days of being admitted to the hospital, I started drinking the juice made from papaya leaves. I was also prescribed tablets to increase the platelet count,” he says.
When should one see a doctor?
One of the most common questions is at what point should one consult a doctor and get admitted to the hospital in case of a falling platelet count.
Dr Sabnis recommends getting admitted in case there is a sense of severity in the symptoms displayed, such as continuous vomiting, change in sensorium (changes in brain function displayed through odd behaviour) breathing difficulties, jaundice, etc.
