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What causes low platelet and hemoglobin counts while treating dengue?

Answered by
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Dr. Eni

General & Family Physician

Practicing since :2015

Answered : 312 Questions

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Posted on Fri, 4 May 2018 in Medicines and Side Effects
Question: My brother was diagnosed with severe dengue in Philippines and has been in hospital for 10 days. He's had another blood transfusion recently (platelet and hemoglobin counts were low) and his fever keeps coming back (not too high), he cannot urinate without the assistance device.

the following has improved
he's now at the lowest setting of oxygen therapy ( got fluid in his lungs)
okay blood pressure
okay heart rate
clear stool (though, liquid)
no more vomitting of blood (sometimes has the urge to vomit)


Is he still in critical condition? whats the reason why his blood count is unstable?
doctor
Answered by Dr. Eni 1 hour later
Brief Answer:
hemorrhage seems to be the reason, and your brother needs to stay in the hospital for the time being.

Detailed Answer:
Hello Dear,
Thank you for posting your question in HealthcareMagic.

I read it carefully and I do understand your concern.

Severe Dengue is a dangerous disease actually, and it takes some time for a patient in a hospital to be totally healed.

The patient may have a high temperature, abdominal ache, and vomiting, may have also some shock features, but what is the most important is the blood hemorrhage. This is the riskiest feature in a severe dengue, and that is the reason that your brother has to keep on staying in the hospital.

Subsequently, he may lose blood (which may be assessed only microscopically) while vomiting, with his stool (although the stool may appear clear, check for dark feces color), he may develop also subcutaneous red spots hemorrhage, and also he may lose blood from his nose.

The blood count needs to be checked often and sometimes these patients may need a repeated blood transfusion.

The fact that with the oxygen he has been improved is a very good thing.

If he has pain, use Only Acetaminophen. The aspirin, naproxen or ibuprofen are Not allowed because they have risks for further blood loss.

Hydration, getting a lot of fluid by mouth or intravenously is also very important.

So, to summarize once more, momentarily with the problematic blood counts your brother needs to stay in Hospital and remained there till he does not have a problem with the blood, hydration, respiration, and pain. Unfortunately there is not a specific medication for Dengue healing, so the doctors will take care to cure his symptoms one by one,

After some time, normally the situation would be okay and he may get back to normal life.
This will usually take 1-2 months.

I wish you all the best,
Hopefully, my answer helped. Feel free to ask further.

Best Regards,
Dr. Eni Manoku


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Eni 3 hours later
Why is he losing blood? He does not vomit anymore or bleed anywhere. His stool is liquid but normal color. He does not have abdominal pain. The only thing is its hard for him to urinate without the assistance device.
doctor
Answered by Dr. Eni 1 hour later
Brief Answer:
This is part of the Disease symptoms. It has to make its course.

Detailed Answer:
Dear XXXX,

Hemorrhage or blood loss can be seen as blood, or unseen. I do suggest that you do a stool (fecal) micro-analysis and culture (for the unseen blood).

It is normal for this Dengue patient to have the problem with blood and to need the blood transfusion. This is part of the disease.

The reanimation and the follow-up symptoms will take some time but he will get better after some weeks.
The improvement of respiration is a very good thing.

Also, it will do good to him to eat well and to consider taking Iron and Vitamin B, for improvement of his blood loss.
Regarding the urination, I think that is normal and he will regain the ability to urinate without the assistance device after some time. This is not to worry.


I really wish your brother a fast recovery!

Best Regards,
Dr. Eni Manoku
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Eni 29 minutes later
What are the foods you recommend i give him? also i just got a news that he will be getting his 3rd blood transfusion because his platelets dropped again. is too much blood transfusion not bad?
doctor
Answered by Dr. Eni 10 minutes later
Brief Answer:
No, it is not bad.

Detailed Answer:
Dear XXXX,

Too much blood transfusion in his case it is absolutely needed and it is not bad.

He should take iron(Fe), vitamins B complex and other multivitamins as well in tablets form.
He should drink fresh fruit juices (any kind), and eat soups with meat. If he is vegetarian then tofu is a good substituent also.

Full wheat bread is good for the gut due to its fiber content.

He should eat 4 times per day at least.
A healthy diet will help his recovery process.

Best Regards,
Dr. Eni Manoku


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Eni 18 hours later
Hi doctor, they would not let us feed him anything.
is there a case where platelets never increase? im scared of losing my brother. the only problem he has now is his plateletes and hemoglobin being very low. will this be corrected no matter what?
doctor
Answered by Dr. Eni 10 minutes later
Brief Answer:
NO, your brother will get better for sure!

Detailed Answer:
Dear XXXX,

The reason that they did not let you feed your brother is because they are probably feeding it intravenously, or with a gastric sond.
You will not lose your brother that is for sure. Your brother will make it, just it will take some time.

Please let me know, how many days is your brother staying in the hospital now?

waiting for your answer.
Dr. Eni

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Eni 32 minutes later
12 days now doctor.

He suffered alot but has improved alot as well

his breathing
he has stable blood pressure (dropped very low at one point)
he doesnt have fever anymore
his heart rate is okay (used to be very rapid)
he urinates now without assistance


some problems
still some fluid left in lungs
low hemoglobin and platelet counts (just finished blood transfusion)
a little bid dark stool but not like before
his stomach always makes noise
no appetite

doctor
Answered by Dr. Eni 8 minutes later
Brief Answer:
C.papaya juice

Detailed Answer:
Dear XXXX,

I've informed you yesterday that he will come to urinate without assistance very soon and I am so happy to hear that he has urinated without assistance, that is so good.

I know from my experience that the platelet counts in these dengue patients are a big concern and that the antimicrobials that they may have given to him, doesn't help that much to increase the platelet.

Normally after the 6th day the platelets become more stabile, if they dont then you should try Carica papaya Leaves Juice. This has proved effectivenes on increasing the platelet. You can discuss this with the doctor or the local pharmacist. Give it to your brother daily and you may see the increase of the platelets.

The loss of the appetitis is normal, it will get better on time for sure.

Let me know how it is going.
I wish him a fast recovery!

Regards,
Eni Manoku MD

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Eni 39 minutes later
We have tried papaya and he just coughs and throws up. :(
so do we not need to worry about him anymoree and just wait for his recovery?
his platelets were actually already okay after his critical stage , i am not sure why it went down again.
doctor
Answered by Dr. Eni 3 minutes later
Brief Answer:
Try again

Detailed Answer:
Dear XXXX,

It is normal that he throws up papaya because they have a very bitter taste.

Try to sweeten them up and please give them again to your brother at least 2 times a day.

That will definitely help! It will even help for the stomach and for the appetite in general.

Best regards



Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Eni 6 days later
Hi doctor. My brother is now out of the hospital. However these past 2 days, he's been getting fever that only last for few hours. Why is that? Should we be worried?
doctor
Answered by Dr. Eni 4 hours later
Brief Answer:
Not really.

Detailed Answer:
Dear,

Thank you for writing again.
It is so good to hear that you brother had such an improvement.

The fever after hospitalization is ok, u can keep an eye on it but nor really worry.
Treat it with acetominophene only.
Do not use any aspirin, ibuprofen or any other FANS, not yet.

What it is "a must" after hospitalization is "eating good and a lot".
Fresh juices, anything that he wants. He need to get power and strength. Feed him good and the his organism will get stronger and stronger.

Write me again if you have other questions,

Regards,
Dr. Eni

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Eni 1 hour later
Thank you so much doctor.
Is paracetamol okay?
His back hurts especially the side? Is this because he's been bedridden for too long?
What's a good multivitamin he can take for him to be healthy?

Love from philippines
doctor
Answered by Dr. Eni 40 minutes later
Brief Answer:
yes. Vitamine C, D, E

Detailed Answer:
Dear XXXX,

Yes paracetamol or acetominophene are the same thing. He can take paracetamol not more than 5 times per day.

I would recommend any kind of supplements taken orally as tablets but the studies showed that Vitamine C, E, and D give the greatest benefit for Dengue patient.

In my opinion eating a lot of food and different food is the best solution.

I wish you all the best!!!
Regards,
Dr. Eni


Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Eni 1 hour later
Thank you doctor. Is back pain especially on the side normal? He keeps asking us to massage his back. Also his breathing is still not smooth
doctor
Answered by Dr. Eni 20 minutes later
Brief Answer:
Pain due to laying down for a long time.

Detailed Answer:
Dear XXXX,
The back pain can be due to laying down in a bed for a long time.
Your brother needs to walk a bit, and the situation with normalise bit by bit.
If it is very bad, then maybe you can make a ultrasound or a MRI to check in details.
I think it will go away after some days.

And regarding to the breath that is because he has been sick for so long, and it takes some time to normalise.

He needs to eat and to walk a little every day to re start the normal life.

Regards,
Dr. Eni


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Eni 9 hours later
Is it normal that he urinated every 10 minutes and always very thirsty? He would always wake us up at night to drink water every 10 minutes and urinate
doctor
Answered by Dr. Eni 1 hour later
Brief Answer:
perhaps normal.

Detailed Answer:
Dear,

Yes, that seems normal and that is good.

Don't worry about it.

Regards,
Dr. Eni


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Eni 26 hours later
Hi doctor. He has bled 3 times in the nose since he got discharged. I am not sure if it is because of the heat because if it was wouldn't we bleed too?

Hi doctor. We just got out of the hospital, had him checked again. We had lab tests everything was normal except his hemoglobin was a little low. They performed ECG and found out his heartbeat is fast. Is this something to worry about? We signed a waiver for him to not get admitted because maybe he can get better at home. What do you think? Is the fast heartbeat due to anemia?
doctor
Answered by Dr. Eni 16 hours later
Brief Answer:
Yes it is.

Detailed Answer:
Dear XXXX,

Yes the bleeding is due to the fever. It is normal that the symptoms to diseppear at all, it will take some days till some week, depending on the individual organism,

The fast heart rate is due to the slightly lower Heamoglobine, so due to anemia.

Did you measure the platelets?
Were they normal?
For the fever he can use Paracetamol ( acetominophene, Tylenol) only! No other drugs, because may increase the risk of heamorrhage,

Let me know again how it is going.

Regards,
Dr. Eni
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Eni 10 hours later
Hi doctor . His fever has stopped. What causes his slight nose bleeding everyday?

What foods and vitamins do I give him for anemia?

Is it okay to take a bath and walk already?
doctor
Answered by Dr. Eni 12 hours later
Brief Answer:
Meat, seafood, dark green vegetables. better not to walk after the bath

Detailed Answer:
Dear,

It is so good to hear that the fever has stopped. The nasal bleeding may be due to the (still) a bit low platelets, but that will normalize soon, I believe it is just a matter of days.

For anemia, I would suggest, Iron, Vit B12, and Vit C supplements as well as meat, seafood, and dark green vegetables. Since you asked for specific food I will attach a list for you:

1. Leafy greens, especially dark ones. They include spinach, XXXXXXX collard greens, Swiss chard, dandelion greens.

Vitamin C helps the stomach absorb iron. Try to eat the green vegetables along with Vitamin C rich fruits and veggies.

2. Meat and poultry: All meat and poultry contain heme iron. Red meat, lamb, and venison are the best sources. Poultry and chicken have lower amounts.

3. Liver: Many people shy away from organ meats, but they’re a great source of iron. The liver is arguably the most popular organ meat. It’s rich in iron and folate. Some other iron-rich organ meats are the heart, kidney, and beef tongue.

4. Seafood: Some seafood provides heme iron. Shellfish such as oysters, clams, and shrimp are good sources. Most fish contain iron. Fish high in iron include sardines, canned in oil, canned or fresh tuna, fresh salmon etc.

5. Beans are good sources of iron for vegetarians and meat eaters alike. They’re also inexpensive and versatile. Some iron-rich options are kidney beans, chickpeas, soybeans, black-eyed peas, lima beans etc.

Regarding the Bath, I would suggest that he walks, but not after the bath, because that may cause a hypotensive situation and we don't want that, so let him relax after the bath and he can walk after some hours. Every day walking will do good.

I hope it helped,
Best Regards,
Dr. Eni


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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