In dengue, the critical phase of plasma leakage usually begins around defervescence, typically days 3–7 of illness. A patient who looks better because the fever has broken may be about to leak. Warning signs — abdominal pain, persistent vomiting, mucosal bleeding, lethargy, liver enlargement, clinical fluid accumulation and a rising haematocrit with falling platelets — mark the patients who need admission and close fluid monitoring. Platelet transfusion does not prevent leakage and is not indicated for a low count alone without bleeding.
- Ask on which day of illness the fever settled; the next 24–48 hours carry the most risk.
- Check for WHO warning signs at every review.
- Follow haematocrit trends — a rise with a falling platelet count signals leakage.
- Do not transfuse platelets for a low count alone in a patient who is not bleeding.
- Titrate fluids carefully; over-resuscitation in the recovery phase causes pulmonary oedema.
Why it matters
Discharging a dengue patient because the fever has gone is the classic avoidable error.
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