Dengue Outbreak: Platelet kit crunch delaying treatment

Treatment of seriously ill dengue patients is being affected by an acute shortage of the kit needed to extract platelets from whole blood in a method that requires only a single donor.

When platelet count plummets in patients, physicians need to give platelets through a vein as quickly as possible.

In order to get enough platelets from one donor, health workers use a device known as apheresis machine to draw blood, extract platelets, and return the blood to the donor.

The process requires a single-use imported kit worth around Tk 9,500, said a private hospital employee, requesting not to be named. The whole process costs between Tk 20,000 and Tk 30,000 at private facilities and up to Tk 15,000 at government hospitals.

As health care facilities often suspend the service due to the kit shortage, platelet-rich plasma is isolated in a method that requires whole blood donated by three or four donors to form a transfusable unit. The blood is not given back to the donors in this method.

As a result, the patients' families have to look for multiple donors in times of dire need. Besides, the process takes hours to complete.

As the number of dengue patients started rising in May, the kit required to operate the apheresis machines became scarce in late July.

Bangabandhu Sheikh Mujib Medical University suspended the platelet extraction service for a week this month.

The scarcity has been more acute at private hospitals.

Green Life Hospital suspended the platelet extraction service last week. The hospital authorities say they had been grappling with kit shortage since the beginning of August.

"Initially, we suspended providing the services to outpatients. Now we don't have any kit in stock," said Abdur Rouf, a technologist at the hospital.

Currently, the National Institute of Cardiovascular Diseases has the service for outpatients.

Prof Rashid-E-Mahbub, president of Bangladesh Health Rights Movement, said, "It was easy to figure there would be a crisis of different medical equipment needed for dengue treatment, but the health officials failed to take steps to prevent it. This happened because we do not have a well-organised health system."

The Daily Star contacted physicians and medical technologists from a dozen private hospitals last week, and all of them said they were facing a shortage of the kit.

At LabAid hospital, Head of Blood Transfusion Medicine Syed Mahboob Karim Shamim said the demand for platelets extraction saw an five to six fold rise this month. 

He received requests for platelets extraction from government and private hospitals, and between  August 1 and 26, the service was given to 200 patients.

Employees of six blood banks at the capital's Mohammadpur, Shyamoli, and Dhaka Medical College Hospital said they were having to turn away people desperately looking for platelets for their loved ones.

They added that the kit importers could be creating an artificial crisis as the demand has gone up.

"This is painful for us too. People break down in tears when we tell them about the suspension of platelet extraction service," said Zahidur Rahman, in-charge of Red Crescent Blood Bank.

Referring to the suppliers of the kit, he said, "We cannot trust businesspeople anymore. They always say there is a shortage. But if you pay them extra money, they will arrange kits for you. But as a charity, we can neither pay them extra, nor charge additional fees from the patients."

An official of a supplier of medical equipment said he hopes the crisis would soon be over.

Contacted, Nurul Alam, spokesperson for the Directorate General of Drug Administration, said, "To our knowledge, there is no crisis of platelet [extraction] kits. And we issued import permission on a priority basis to the importers."