Evaluation of 303 Cases of Thrombocytopenia

ABSTRACT

Thrombocytopenia is a common clinical problem with many etiological causes. Although transient bone marrow suppression and marrow infiltration by malignancies are important causes, certain non-malignant conditions such as nutritional causes and infections are equally important as the treatment is simple and cure is possible. Depending on the aetiology, the clinical presentation may vary. Knowing the exact aetiology is important for specific treatment and prognostication. A total of 303 cases of thrombocytopenia were studied out of which males were 44% and females were 56%. The patients’ age ranged from 5 months to 84 yrs. The commonest presenting symptom was fever with bleeding manifestations and jaundice. 14% of cases are of Grade 1, 20% of the cases of Grade 2, 5% of cases of Grade 3 and 31% of cases had counts less than 25000/cu.mm i.e. of Grade 4. 50% of cases in Grade 4 had a decreased number of megakaryocytes in the bone marrow. The most common cause of thrombocytopenia in our study was megaloblastic anaemia (48.6%), ITP (20%), post-viral (10.9%) followed by leukaemia, aplastic anaemia and others. Thrombocytopenia has a spectrum of causes which can be diagnosed by detailed history and peripheral smear examination supported by bone marrow examination. Megaloblastic anaemia was the commonest cause of thrombocytopenia followed by immune thrombocytopenia. Unlike in the western India megaloblastic anemia is highly prevalent and is the leading correctable cause of thrombocytopenia. Most of the patients with Grade 4 thrombocytopenia had a decreased number of megakaryocytes in the bone marrow suggesting a production defect.