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

Author(s): Sreelatha Martha1, Goutham Deeti2, Chaitanya Jyothi Ravula3, Nirmala Cherukuri4, Srinivasa Suresh Nadavapalli5

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.
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.
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.
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.