Clinicoetiological profile and outcome of acute febrile illness with thrombocytopenia in children: a hospital based prospective study

'Background: Thrombocytopenia is often the most commonly encountered clinical condition in this routine practice. Etiological causes being numerous, often pose a challenge in evaluating and treating the patients. The objective of this study was to find out the different causes and clinical profile of fever with thrombocytopenia in children aged 1month to 14 year who were admitted in this set up.Methods: This was a prospective study done on 200 patients with thrombocytopenia admitted IMS AND SUM Hospital, BBSR with various complaints, during the period of 01 August 2017 to 01 August 2019. This study includes age group 1months to 14 years.Results: The highest incidence of thrombocytopenia belonged to the age group 11-14 years (22.5%) followed by 6-9 years (19.5%) and 3-6 years (18%). Incidence of thrombocytopenia was more in male child (58.5%) as compared to female child (41.5%). the most common cause of thrombocytopenia was dengue (50%), Scrub typhus (34%) septicaemia (17.5%) followed by malaria (10.5%). Among the infectious aetiology severe thrombocytopenia was seen more in dengue (25%) and scrub typhus (34.5%) but evidence of bleeding was seen more in sepsis (34.2%) even with higher platelet count which may be explained by associated multi organ failure.Conclusions: Infections like malaria, dengue, leptospirosis and septicaemia were the common causes of thrombocytopenia along with scrub typhus. Whenever thrombocytopenia is detected further investigations can help us in reaching a correct diagnosis in the majority of the cases so that appropriate treatment can be given and also to avoid unnecessary platelet transfusion to prevent transfusion related complications.

Analysis of predictors in outcome of fever with thrombocytopenia of pediatric age upto 12 years

Background: It is well recognized that many fetomaternal and neonatal conditions are associated with thrombocytopenia. Study aimed to establish the possible etiology of children presenting with thrombocytopenia.Methods: The study was carried out in 100 children 1 month-12 years, admitted at department of paediatrics, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India with fever and thrombocytopenia. A thorough history was obtained and a general and systemic examination done. Routine investigations were done in all cases and specific investigations as and when required.Results: Total 100 cases were studied. Among them, 65% developed only fever, 10% developed fever with bleeding and 25% developed fever with shock. In total admissions 55% of children admitted with warning symptoms including abdominal pain, vomiting, reduced urine output and black colored stools. There is a significant influence of warning symptoms in predicting the outcome of fever with thrombocytopenia. 30% of children admitted with respiratory distress. 30% of children admitted with abdominal distension. 60% children admitted with hepatomegaly. In these children, 20% of them developed fever with shock and 13% of them developed fever with bleeding, 52% children admitted with platelet count less than 1 lakh. In these patients, 19% of them developed fever with shock and 9% of them developed fever with bleeding. 60% had dengue serology positive, 12% had positive Widal test, 8% children had positive urine culture and sensitivity. There was a significant influence of etiology in predicting the morbidity as 15% of children having positive serology for dengue developed fever with shock. 10% of children having positive serology for dengue developed fever with bleeding. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/?l.Conclusions: The commonest cause of febrile thrombocytopenia in this study was dengue fever in Children. Platelet count was the predictive of bleeding manifestations.

Thrombocytopenia in children: a clinico-etiological profile in an urban tertiary care hospital

Background: Thrombocytopenia is a common haematological finding that we come across while managing a sick child. Etiological profile and presentation of thrombocytopenia varies among children. The objective of this study was to study the clinical and laboratory profile of children with thrombocytopenia, associated clinical complications and assess the relationship between platelet levels and severity of disease.Methods: The study was carried out in 644 children between 1 month and 12 years, admitted in Paediatric Department of Raja Rajeshwari medical college and hospital, Bangalore between August 2012 to August 2014.Results: The commonest causes of thrombocytopenia in our study were of infectious aetiology (86.6%). Among Infections Viral infections were the major cause in more than 78% of cases. Other causes included haematological problems, drug induced thrombocytopenia and connective tissue disorders. Bleeding manifestations were present in 33.07% of patients and the commonest bleeds were skin and mucous membranes. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/'l.Conclusions: Viral Infections were the commonest cause for thrombocytopenia in Children. Platelet count was neither predictive of bleeding manifestations nor predictive of need for platelet transfusion.

Coagulopathy in dengue fever patients.

Background: The study was done to find out the prevalence of coagulopathy in Dengue fever patients with thrombocytopenia and its clinical significance. Methods: The patients admitted in medical wards and ICU were included in the study after considering certain inclusion and exclusion criteria. APTT, PT & D-dimer assays were also done in the study population. Coagulopathy was considered when APTT values were ≥41seconds. Results: 22.3% of the study population showed evidence of coagulopathy. Bleeding manifestations significantly increased with increasing APTT values. There is also significant association between platelet counts and bleeding manifestations. As platelet count falls there is a tendency for APTT to rise. Conclusion: In addition to thrombocytopenia, coagulopathy also contribute to the presence of bleeding manifestations in dengue fever patients. There is a significant correlation between bleeding manifestations with abnormal APTT values. As platelet count decreases there is tendency for rise in APTT values.

Chronic myelogenous leukemia in children

A case of chronic myelogenous leukemia in a 4 month old Filipino infant, whose apparent onset was at 2 months of age, is reported. The clinical course and hematological picture of this case followed the usual features of the disease as observed in infants mainly that of hepatosplenomegaly with bleeding manifestations, hyperleukocytosis with anemia and thrombocytopenia, and a relatively short course unresponsive with the usual therapeutic measures for chronic myelogenous leukemia. Terminally the patient manifested the picture of "blastic" crisis. (Summary)