Abstract

Objective: To study correlation between etiology and clinical profile of patients presenting with fever and thrombocytopenia, to study correlation between bleeding manifestations and platelet count and to study predictive value of Hess tourniquet test in patients with fever and thrombocytopenia. Study design: prospective observational study. Methods: In present study 150 children from age 2 months to 12 years who presented with fever and thrombocytopenia were included using simple random sampling method. Patients were evaluated thoroughly .Detail history was taken and general examination, systemic examination and Hess tourniquet test was performed on each patient and results were recorded. All patients who were included in study underwent necessary investigations including Complete blood count, Peripheral smear, Haematocrit, LFTs, KFTs, Serum electrolytes, Serum proteins, Dengue IgG and IgM, Chikungunya IgG and IgM, Rapid malaria test, Widal test, Tourniquet test, Blood culture, X-ray chest and USG abdomen .In special situations other tests like Coagulation profile, Weil Felix test, IgM ELISA for leptospirosis, CSF study, NCCT / MRI Brian were done. These patients were followed up and their course in ward, treatment and its outcome was noted. Results: Out of 150 cases Dengue fever was major cause accounting for 69 (46%) of total cases second major cause was Unspecified Haemorrhagic Fever accounted for 41(27.3%) followed by Malaria accounted for 21(14%), Enteric Fever accounted for 12(8%), Rickettsial Fever accounted for 06 (4%), Leptospirosis 01 (6%). Bleeding manifestations were present in 95/150 pts in the form of petechie, hematemesis, malaena, epistaxis. 6.3% of patients who had bleeding manifestations had platelet count in the range of 0-20 thousand/cumm, 31.5% of patients had platelet count in the rangeof 20-50 thousand/cumm, 62.1% of patients had platelet count in the range of 50-100 thousand/cumm. Torniquet test was positive in 16% of cases of total cases and negative in 84% of cases. Among positive cases DHF contributed to 54%, Unspecified haemorrhagic fever contributed to 29%, Dengue Fever 12%, DSS 4% of total positive cases. Maximum mortality was in Dengue infection which contributed to 77.7% of deaths followed by Unspecified Hemorrhagic fever, which contributed to 22.2 % of total deaths. Conclusions: Infection is the commonest cause of fever and thrombocytopenia. Dengue fever found to be largest group with 69(46%) followed by Unspecified haemorrhagic fever 41(27.3%), malaria 21(14%),Enteric fever 12(8%),Rickettsial fever 6(4%) and Leptospirosis 1(0.6%). There is no correlation between platelet count and bleeding manifestations. Tourniquet test is a very nonspecific tool for classification of DHF and DF patients and also it is not an early predictor of spontaneous hemorrhage.

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