A prospective study of clinical assessment of fever with thrombocytopenia

Fever is defined as elevation of normal body temperature above the normal circadian variation3. Thrombocytopenia is defined as platelet count <1,50,000/microliter. Infection is the most common cause. Fever with thrombocytopenia narrows the differential diagnosis of the clinical entity. A well organised systemic approach is carried out with an awareness of cause of fever with thrombocytopenia to shorten the duration of investigation and bring out diagnosis. Aims and objectives: 1. To study incidence of various etiological agents for patients getting admitted for fever with thrombocytopenia. 2. To analyse epidemiological data, clinical features, investigations, incidence of complications and outcome of patients. Material and Methods: This is a prospective study done in patients admitted for fever with thrombocytopenia in NRI Institute of medical sciences, Sangivalasa, Visakhapatnam, India, over a period of one year from Jan 2017 to Dec 2017. 100 patients are selected based on inclusion and exclusion criteria. Based on symptoms, signs and investigations etiological factors were analysed and diagnoses were done.. Results: 100 cases were admitted with fever with thrombocytopenia. Out of this 100 cases, 70 cases were male and 30 cases were female with male female ratio of 2.3:1. Most of the cases admitted between age 26 to 35. The mean age for male and female cases was 33.76 and 33.1 respectively. The most common cause is infectious, of which dengue is most common (42%) followed by malaria (21%). Petechiae is common bleeding manifestation. Blood transfusion is not needed for all the cases even when platelet is below 20,000. Acute renal failure is the common complication. Mortality is 8%. Conclusion: Fever with thrombocytopenia is one of the most challenging problems in field of medicine. Infection is the most common cause. Dengue, malaria, leptospirosis still present clinically in atypical and occult form, making diagnosis more difficult. So specific tests like rapid spot test, IgM ELISA for dengue, IgM ELISA leptospirosis antibodies, widal test etc are required for correct diagnosis. Spontaneous bleeding was noted in patients with platelet count <20,000. Platelet transfusion is not needed for all the cases. Overall mortality for fever with thrombocytopenia is 8%.