Clinical profile, laboratory parameters and severity predictors in children with fever and thrombocytopenia- experience of a tertiary care centre

Abstract

Background and Objectives. Fever with thrombocytopenia is a common clinical entity that refers to reduction in platelet count below age and sex reference values in a febrile child. With early recognition, risk stratification and prompt treatment, morbidity and mortality can be limited. However, undue anxiety in parents or treating doctors may prompt one to do unnecessary platelet transfusions. In thisstudy, we intended to study clinical profile, laboratory parameters and severity predictors in children with fever and thrombocytopenia. Methodology: We conducted this prospective observational study over 1 year from April 2019 to March 2020 at department of Pediatrics, NMCH, Patna, Bihar including children of 1-14 years of age with fever and platelet count below 150000/mm3 with or without bleeding. Results: Over the study period, we enrolled 120 children with febrile thrombocytopenia. Mean age was 6.9 years and most of the affected children were in 5-10 years age group (43.3%). Incidence of febrile thrombocytopenia was highest between months of July & September (44.2%). Other presenting features werebody ache (60.8%), headache (55.8%) and joint pain (48.8%) etc. Common etiologies were dengue fever (25.8%), unspecified viral illness (17.5%), septicemia (10%), ITP (7.5%), enteric fever (6.67%) etc. Only 26 (21.7%) suffered from bleeding manifestations. Skin bleeds were the commonest bleeding manifestation (34.6%) followed by gum bleeding (23.1%), hematemesis (7.7%), hematuria (7.7%) etc. Duration of fever >5 days, hemodynamic instability, hepatomegaly, platelets count <10,000/cu mm, abnormal KFT and elevated liver enzymes were associated with a significant higher risk of bleeding.Conclusion: Febrile thrombocytopenia is most frequently caused by infections: viral diseases (dengue, chikungunya and other viruses), malaria, enteric fever etc. Clinical features are reflective of the primary disease/condition as well as bleeding manifestations. Late presentation to hospital, prolonged fever and end organ damage influence outcome in these children.