Platelet Transfusion in Dengue-Associated Thrombocytopenia: A Systematic Review and Meta-Analysis

Area of Science:

• Infectious Diseases
• Hematology
• Clinical Medicine

Background:

• Thrombocytopenia is a severe dengue hemorrhagic fever manifestation, increasing hemorrhage risk.
• Prophylactic platelet transfusion (PT) is considered for preventing hemorrhagic complications.

Purpose of the Study:

• To evaluate the efficacy and safety of prophylactic platelet transfusion in dengue-associated thrombocytopenia.
• To assess PT's impact on platelet recovery, mortality, bleeding, and hospital stay.

Main Methods:

• Systematic literature search of RCTs and cohorts in major databases (PubMed, Cochrane, Web of Science, Scopus, Embase) up to November 2025.
• Included 9 studies (6 retrospective cohorts, 2 RCTs, 1 prospective cohort) with 3,377 patients (2,383 in PT group).
• Assessed risk of bias using RoB 2 and ROBINS-I tools.

Main Results:

• PT did not significantly reduce time to platelet recovery (MD: 0.73 days; 95% CI: -0.01 to 1.47) or length of hospital stay (MD: 0.53 days; 95% CI: -0.15 to 1.22).
• PT was associated with significantly higher mortality (RR: 3.61; 95% CI: 1.12-11.66) and bleeding events (RR: 1.37; 95% CI: 1.03-1.82).
• High heterogeneity (I² > 95%) noted for recovery time and hospital stay.

Conclusions:

• Prophylactic platelet transfusion offers no clear benefit for dengue-associated thrombocytopenia.
• PT is associated with increased risks of mortality and bleeding, contraindicating its routine use.
• Current evidence, primarily from retrospective studies, necessitates further high-quality randomized trials.