CLINICAL AND ETIOLOGICAL PROFILE OF FEBRILE ILLNESS WITH THROMBOCYTOPENIA

Abstract

Introduction:  With the raising of the body that exceeds the normal variation which occurs in conjunction with an increase hypothalamic set point is known as fever. Thrombocytopenia is a common clinical condition which is caused by infectious and noninfectious etiology. This may results from one or more of these three processes: decreased bone marrow production; Sequestration, usually in an enlarged spleen; and /or Increased platelet destruction. Either inherited or acquired there may be disorders of production. Showing low platelet count is obtained. Thrombocytopenia refers to decrease in platelet count below 1.5 lakh/microliter. Especially in tropical country like India, infectious causes prevail and are usually associated with fever; also drugs, Hypersplenism, DIC, autoimmunity and malignancy are among the leading causes of thrombocytopenia. Hence, platelet counts are liable to error, a single platelet count that is lower than normal should be confirmed by a second count. It should be also confirmed by inspecting the blood film. Aim: The aim of this study is to evaluate clinical and etiological profile of febrile illness with thrombocytopenia. Material and methods: This is prospective study conducted in Department of General Medicine of Prasad Institute of Medical Sciences and Prasad Hospital Lukhnow, India during 1 year. Total 150 patients were included in this study. Patients with more than 12 year of age were presenting with thrombocytopenia platelet count <1 lack/ mm³ (with or without clinical bleeding). In all the patients Detailed physical examination was done as well as  Detailed clinical history was noted in each patient including site of bleeding, past history of drug and major medical illness as chronic thrombocytopenia, malignancy, patients on chemotherapy  were also noted.  Routine Investigation in form of platelet counts, CBC, RFT, LFT, Coagulation Profile and chest x-ray etc were done on the day of presentation. Result: Maximum number of cases were seen in 21-30 years of age group (27.3%) followed by 31-40 years (24.0%) and 90 (60.0%) were males and 60 (40.0%) were females. It was seen that most common cause of thrombocytopenia was infection dengue (28%), malaria (23%) and followed by septicemia (12%), enteric fever (9%), UTI (8%) and so on..  It is also shown that platelet count less than 20,000/mm³ is maximum in number of patient and also  categorized patients with low platelet and  etiology into mild with platelet 50,000/mm³ -1,00,000/mm³, moderate with plate 20,000/mm³ -50,0000/mm³ and severe with plate< 20,000 mm³. out of 150 patients, 17 (11%) had Hemorrhagic manifestations, of which most common site of bleeding was skin and mucous membrane (35%) followed by Bleeding per vagina(24%),  gum bleeding (12%) and Hematuria (12%) and so on. Conclusion: Prevalence of febrile thrombocytopenia is more due to infectious etiology are in young, in male. The commonest cause of febrile thrombocytopenia is dengue followed by malaria and septicemia. There is no correlation to mortality and morbidity with Thrombocytopenia. The main cause of Thrombocytopenia was dengue fever and majority patients had platelet count < 10,000/mm³ and septicemia was commonest etiology.

Keywords: Thrombocytopenia, Fever, Platelet, Platelet, Dengue