A Prospective Study of Clinical Profile in Febrile Illness with Thrombocytopenia in Children Aged 1 to 12 Years Admitted in a Tertiary Care Centre in Telangana

BACKGROUND Fever with thrombocytopenia is a common clinical problem in paediatric wards. Significant number of acute febrile illnesses have an infectious aetiology and are often associated with thrombocytopenia. The objective of the study was to determine the clinico-etiological profile and outcome of children admitted with febrile thrombocytopenia, especially in those with infective aetiology. METHODS The study design is a prospective observational study. It was conducted from September 2017 to August 2019 in the Department of Paediatrics, Niloufer Institute of Women and Child Health, Hyderabad. A total of hundred (100) children in the age group of 1 year to 12 years presented with fever, and thrombocytopenia were included in the study. Newborns, infants, children with febrile thrombocytopenia, known ITP (idiopathic thrombocytopenic purpura), already diagnosed haematological malignancy and children on antiplatelet drugs like aspirin were excluded from the study. After informed written consent, detailed history was elicited, clinical examination and necessary laboratory investigations were carried out, and the data was captured in a pre-structured proforma. Study parameters were analysed using Statistical Package for Social Sciences (SPSS) version 16 software. RESULTS The study included 100 children. A ratio of 1.4 : 1 was observed in male to female ratio. As of the clinical features, gastrointestinal (GI) symptoms such as nausea, vomiting and pain abdomen were more common, followed by headache and myalgia. On examination, two-thirds of the children had hepatomegaly, and onethird had splenomegaly. Among 100 children with febrile thrombocytopenia, 38 children had bleeding manifestations (cutaneous bleeds > GI bleeds > other bleeds) in those with moderate to severe thrombocytopenia. In the etiological profile, dengue fever was more common, followed by undiagnosed fever, enteric fever, ALL (acute lymphoblastic leukemia), scrub typhus, malaria and leptospira, respectively. Out of 100 children, 94 were discharged, and 6 children with ALL were referred to the haemato-oncology center for further management. CONCLUSIONS Clinical presentation of cases with febrile thrombocytopenia is varied. Common causes of febrile thrombocytopenia observed in this study were dengue fever followed by un diagnosed fever and enteric fever. KEYWORDS Fever, Thrombocytopenia, Platelet count, Bleeding