Clinical, etiological and laboratory profile of febrile thrombocytopenia and correlation of platelet count with outcome in a South Indian tertiary hospital

Background: Febrile thrombocytopenia is commonly encountered by doctors especially during monsoon and peri-monsoon period, many of these patients have a turbulent cthisse with multi organ dysfunction and might land up in ICU with significant morbidity and mortality. Infections are the commonest causes of thrombocytopenia and they vary with season and geographical location. A systematic approach, carried out with an awareness of causes, clinical presentation and laboratory profile of febrile thrombocytopenia can shorten the duration of investigations and bring out the diagnosis early, reducing morbidity and mortality of patients and reducing burden on hospital resthisces. The objective of the study is to study the underlying etiology, the various clinical presentations, laboratory profile and complications of fever with thrombocytopenia in this community during monsoon period and to correlate thrombocytopenia with outcome, co morbidities and its etiology.Methods: The prospective observational study was conducted in tertiary centre in Kolar between June-December 2017. Patients meeting inclusion and exclusion criteria were grouped into 4 groups based on platelet counts, and correlated with comorbidities, etiology and outcome. Detailed clinical and laboratory examination were done in all patients and p value of <0.05 was considered statistically significant.Results: Among 465 patients were included in the study. Dengue was the most common cause for febrile thrombocytopenia and mortality. Hepatic complications and petechiaes were the most common complications and bleeding manifestations. 135 patients received platelet transfusion but there was no relationship between platelet transfusion and outcome, there were 9 deaths in the study and there was no association between death and platelet count at admission.Conclusions: There was no relation between platelet count on admission and mortality and also there was no relationship between platelet transfusion and outcome. Knowing the clinical presentation, etiology, complications and its monitoring can significantly reduce the morbidity and mortality due to febrile thrombocytopenia.

Systemic evaluation of febrile thrombocytopenia

Background: Febrile patient with thrombocytopenia is commonly encountered by physicians especially during monsoon and perimonsoon period. Infections with protozoa, bacteria and viruses can cause thrombocytopenia with or without disseminated intravascular coagulation. Commonly dengue, malaria, scrub typhus and other rickettsial infections, meningococci, leptospira and certain viral infections present as fever with thrombocytopenia. Occasionally these patients can go on to develop a stormy course with multiorgan dysfunction requiring intensive care unit admission associated with high morbidity and mortality. Though thrombocytopenia is encountered in various diseases, it is for sure that potentially fatal bleeding due to thrombocytopenia is rare. The study was intended to know the underlying etiology of febrile thrombocytopenia in our community, the various presentations and relationship between platelet level and severity of disease and prognosis.Methods: This study was carried out in 218 adult patients (age above 18 years) presenting with fever having thrombocytopenia (platelet count <1,50,000/mm3) in Dept. of medicine in IIMS and R Lucknow UP.Results: Dengue was the commonest cause of fever with thrombocytopenia (58.71%) followed by P. falciparum malaria 8.71% and P. vivax malaria 6.88%. Bleeding manifestations were seen in 24.31% of patients. 58.49% of patients had patechie/purpura as the commonest bleeding manifestation followed by hematuria in 16.98 %.Conclusions: Fever with thrombocytopenia consists of occult presentations of common diseases rather than rare disease. Infection is the commonest cause of fever with thrombocytopenia. Among infections, dengue was the commonest cause. Treatment of underlying condition will lead to rapid improvement in platelet count with complete clinical recovery.

A Clinical Study of Febrile Thrombocytopenia: A Hospital-based Retrospective Study.

Introduction: Febrile thrombocytopenia is a usually condition commonly caused by infections. The present study is intended to know the underlying etiology of febrile thrombocytopenia in our community, the various presentations and relationship between platelet count and severity of disease and prognosis. Material and methods: The study was conducted on 190 patients who presented with fever and thrombocytopenia and were admitted in Sri Ram Murti Smarak Institute of Medical Sciences (SRMS-IMS), Bhojipura, Bareilly, Uttar Pradesh from January 2011 to December 2011. Results and observations: Febrile thrombocytopenia affected all age group ranging from 18 to 88 years of age but was common in 18-40 years age group (52%) with male-to-female ratio 66.3:38.9%. It was common during the months of July to September. Fifty percent patients were having platelet > 50,001/mm3. Malaria was the commonest cause constituting 32.6%, which was closely followed by septicemia forming 31.2%. About 76.8% patients had good recovery. In 18 mortality cases, 83.33% were due to septicemia with multiorgan dysfunction and 16.67% were due to complicated malaria. Conclusion: Febrile thrombocytopenia is an important clinical condition commonly caused by malaria and septicemia.