Author(s): Ravindra Kumar Sudarsi1, Markandeya Rao G. K2, Nanditha Nallamanddi3, Giridhar Gorrepotu4

The aetiologies of thrombocytopenia are diverse. Various studies on thrombocytopenia done in the past have related to specific aetiologies. This study attempts to determine the common aetiologies of thrombocytopenia and bleeding manifestations in adult patients admitted under Department of Medicine.
Patients older than 18 years of age who were first time found to have thrombocytopenia at admission under Department of Medicine between 1st October 2014 and 31st September 2015 were followed up during their stay in hospital and the diagnosis made, bleeding manifestations, and requirement of platelet transfusions were recorded.
200 patients were included in the study. Dengue/dengue-like fever was the diagnosis made in 30% of patients followed by malaria (22%), undiagnosed aetiology (9%), HELLP (6%), snake bite and sepsis 5% each, ITP and megaloblastic anaemia 4.5% each, haematological malignancies and CTD 3% each, and other rare causes formed the rest.
Bleeding secondary to thrombocytopenia was seen in 36 patients. 22.2% of them were diagnosed as dengue, 19.4% had malaria, 16.7% had ITP, 11.1% of patients with HELLP, 8.3% each had malignancy and undiagnosed viral infections, 5.6% each had CTD and MDS, and 2.8% had aplastic anaemia.
Dengue fever was responsible for thrombocytopenia-related bleeding in 8 cases, ITP in 6 cases, malaria in 7 cases, HELLP in 4 cases, malignancy and undiagnosed aetiology 3 cases each, CTD and MDS 2 cases each, and aplastic anaemia in 1 case.
The common bleeding manifestations were GIT (Melena), petechial rash, and menorrhagia occurring in 33.3%, 22.2% and 13.8% of total number of patients respectively.
30.5% of those who had bleeding secondary to thrombocytopenia had platelet count <5000/μL. 68.7% of those with platelet count <5000/μL had bleeding manifestation.
36.6% of those who had bleeding secondary to thrombocytopenia had platelet count 5,000-10,000/μL. 65.0% of those with platelet count 5,000-10,000/μL had bleeding manifestation.
46 patients were given platelet transfusions, 65.2% of these cases were transfused because of bleeding and 34.78% were prophylactic.
Dengue fever was the commonest cause of newly found thrombocytopenia in adult patients admitted under Department of Medicine. The commonest bleeding manifestation secondary to thrombocytopenia was GIT bleed. Though, Dengue and Malaria were the most common aetiology diagnosed in patients with bleeding secondary to thrombocytopenia, the proportion of aplastic anaemia, MDS, and ITP patients who had bleeding manifestation was higher than the proportion of Dengue and Malaria patients who developed bleeding. Major proportion of bleeding manifestation occurred in patients with platelet count <5000/μL. There was no definitive trigger value of platelet for platelet transfusion and transfusion because of bleeding was greater than prophylactic transfusion.

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