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Category: Volume 05 Issue 10 October 2017
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Title: Haemorrhagic Tendencies in Patients Presenting with Fever and Thrombocytopenia in a hospital setting - A Cross Sectional Study

Authors: Jacob K. Jacob, Ranjith P. S., Aswathyraj S., Asaraf B. K., Praveen G. S., Dr Shiji K Jacob

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.147

Abstract

Background: Fever with thrombocytopenia has become the commonest presenting problem in the medical wards. Infection is a common cause of thrombocytopenia. Fever with thrombocytopenia is a common condition that is associated with an increased risk of morbidity and mortality. Infections like Malaria, Dengue, Typhoid and septicaemia are some of the common causes of fever with thrombocytopenia.

Aims and Objectives: To study the clinical profile of febrile thrombocytopenia’s and to determine the etiology of these febrile illnesses. Also to observe the different bleeding manifestations in order of their incidence in fever with thrombocytopenia and their relation with platelet count.

Methods: During the period between 1 January 2015and 31 December 2015 a cross-sectional study was carried out at Govt. Medical College, Ernakulam, Kerala. Patients with febrile thrombocytopenia and age more than 13 years were followed up, diagnosis were made, and bleeding manifestations and requirement of platelet transfusion were recorded.

Results: Among the 123 patients studied, common etiology of febrile thrombocytopenia found was dengue (n=51, 41.4%), followed by malaria (n= 8, 6.5%), and Leptospira (n=7, 5.6%).Among the study group, 35.77% had mild platelet count (platelet count below 1 lakh to 50,000), 39.6 % had platelet count in the range of 50,000 -20,000 and 25.2 % had platelet count less than 20,000. 11 cases (8.94%) were presented with bleeding manifestations. Out of this; 4 (3.25%) showed nose/gum bleed, 3 (2.44%) had melena, 2 (1.63%) cases presented with vaginal bleed, 1 (0.81%) sub-conjunctival haemorrhage and   1 (0.81%) presented with haematuria. Rash was observed in 5.6 % of the cases. Good recovery was noted in 93% cases while 3% had mortality and remaining 3 % were referred for better treatment.

Conclusions: In our set up infections like Dengue fever was the common cause of fever with thrombocytopenia followed by malaria and Leptospirosis. Thrombocytopenia due to infectious agents shows seasonal variation with peak of incidence in soon after monsoon and early winter season. All cases of thrombocytopenia may not have a bleeding manifestation and may be asymptomatic at initial presentation.

Keywords: Fever, Thrombocytopenia, Malaria, Dengue, Spontaneous bleeding, Leptospirosis.

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Corresponding Author

Jacob K. Jacob

Professor, Department of General Medicine,

Government Medical College Ernakulam

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