A study of clinical and laboratory evaluation and outcome of patients with acute febrile illness with thrombocytopenia

Abstract

Introduction: Fever with thrombocytopenia has become a common presenting problem. Infection is the main cause of thrombocytopenia. Fever with thrombocytopenia is frequently associated with an increased risk of morbidity and mortality. Infections such as malaria, dengue, enteric fever, and septicemia are some of the major causes of fever with thrombocytopenia in India. Aims and Objectives: To evaluate clinical profile of febrile thrombocytopenia, to identify different causes and the most common cause of febrile thrombocytopenia, and to assess the outcome and complications associated with febrile thrombocytopenia. Materials and Methods: A cross-sectional study of 160 patients was carried out at Basaveshwar Teaching and General Hospital. Patients with thrombocytopenia who were ≥18 years of age at admission between November 2016 and May 2018 were observed and followed up during their stay in hospital, diagnoses were made, and bleeding manifestations and requirement of platelet transfusion were also recorded. Results: Febrile thrombocytopenia affected all age groups ranging from 18 to 75 years of age but was common in 21–30 years of age group (40.60%), with a male-to-female ratio 57:43. Infection (88.12%) was the most common cause of thrombocytopenia, while dengue (53.13%) was the most common of the infections followed by malaria (15.63%) and septicemia (8.75%). Bleeding manifestations were seen in 33.13% of patients. 81% of the patients with bleeding tendencies had petechiae/purpura as the most common bleeding manifestation, followed by spontaneous bleeding in 54.70%. Melena (34.48%) was the most common among spontaneous bleeding. Bleeding manifestations were more common when the platelet counts were <20,000 cells/cumm. Good recovery was noted in 92.50%, while 5% had mortality and 2.50% cases were referred. Septicemia was the major cause of mortality. Conclusion: In our setup, infection such as dengue fever was the common cause of fever with thrombocytopenia followed by malaria and septicemia. In majority of patients, thrombocytopenia was transient and asymptomatic, but in significant number of cases, there were bleeding manifestations. On treating the specific cause, drastic improvement in the platelet count was noted. Mortality in febrile thrombocytopenia is not directly associated with degree of thrombocytopenia but with concomitant involvement of other organs, leading to multiorgan dysfunction.

Keywords

• dengue
• fever
• malaria
• spontaneous bleeding
• thrombocytopenia