Thrombocytopenia and platelet dysfunction are common occurrences in both dengue and COVID-19 and affect clinical outcomes. An acute dengue infection activates Coagulation and fibrinolytic pathways, while severe dengue causes endothelial dysfunction. On the other hand, COVID-19 features a high prevalence of thrombotic complications, with rare episodes of bleeding, which occurs only in advanced stages of critical illness. In COVID-19, thrombin acts as the central mediator that activates endothelial cells and elicits a pro-inflammatory reaction followed by platelet aggregation. Serological cross-reactivity may happen between COVID-19 and dengue infection. 

Anticoagulation with or without aspirin is an important management aspect of COVID-19-induced immunothrombosis associated with thrombocytopenia. Dengue, however, prohibits the use of aspirin, nonsteroidal anti-inflammatory drugs, and anticoagulants. Mild to moderate dengue infections are manageable with supportive therapy and paracetamol for fever. Severe infections, like dengue hemorrhagic fever and dengue shock syndrome, frequently demand escalation to higher support levels in a critical care facility. 

The function of therapeutic platelet transfusion is equivocal and must not observe in routine use in patients with dengue with thrombocytopaenia and mild bleeding. 

In low- and middle-income countries, the use of prophylactic platelet transfusions in dengue fever has strained healthcare systems and contributed to transfusion-transmitted infections.

More research is needed to describe the management of dengue with significant bleeding.

Source:  Islam A, Cockcroft C, Elshazly S, Ahmed J, Joyce K, Mahfuz H, Islam T, Rashid H, Laher I. Coagulopathy of Dengue and COVID-19: Clinical Considerations. Tropical Medicine and Infectious Disease. 2022; 7(9):210. https://doi.org/10.3390/tropicalmed7090210