Risk of Spinal Hematoma in Dengue Fever

Clinical Considerations

• Platelet counts can drop precipitously (by approximately 43% from baseline) within 1-2 hours even when initially normal, particularly during the critical phase (days 3-7) 1
• The American Society of Regional Anesthesia and Pain Medicine recommends maintaining platelet count >50 × 10⁹/L minimum for any invasive procedure, with consideration for higher thresholds (>100 × 10⁹/L) for neuraxial procedures given the catastrophic consequences of spinal hematoma 1
• Monitor platelet counts at least every 4 hours after any intervention, as counts can drop rapidly 1
• Avoid NSAIDs and aspirin which further increase bleeding risk 5
• Recognize that bleeding can occur without warning during the critical phase even with initially reassuring laboratory values 5, 1

Coagulation Management

• Do not use INR alone - PT ratio (not INR) should be monitored and kept <1.5 in coagulopathic patients 2, 3, 4