Clinical Score for Risk Stratification in Febrile Thrombocytopenia
Journal Title: Journal of Clinical and Diagnostic Research - Year 2019, Vol 13, Issue 5
Abstract
ABSTRACT Introduction: The monsoon and peri-monsoon season often entail, a high patient influx with fever and thrombocytopenia. In severe cases, blood transfusion is necessary, but as there are no guidelines or a precise laboratory cut-off for platelets at which transfusion is requisite, unwarranted blood transfusions adversely affect the patients and overwhelm blood banks. Kshirsagar P et al., developed a risk assessment score system for febrile thrombocytopenia to aid in determining therapeutic intervention. Validation of this scoring system on a larger sample size is imperative, taking into consideration both aetiology and comorbidities. Aim: To validate clinical scoring system developed by Kshirshagar P et al., and to correlate etiology, comorbidities and platelet count with clinical score and outcome in patients with febrile thrombocytopenia. Materials and Methods: The prospective observational study was conducted in a tertiary centre in Kolar. Patients >18 years with temperature >99°F and platelet count <1,50,000/cumm, were scored according to Kshirshagar P et al., scoring system and then categorised into low (≤7), moderate (8-15) and high-risk (16-26) groups. Based on pulse, temperature, respiratory rate, blood pressure, platelet count, central nervous system, respiratory, haematological, hepatic and renal complications, the outcome was assessed for each group. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20 software. Non parametric Chi-square, unpaired Student’s t-test and one-way ANOVA were applied in comparative analysis results between different groups. The p-value <0.05 was considered as statistically significant. Results: Between June-December 2017 (monsoon period) 465 patients were admitted with febrile thrombocytopenia. Based on the clinical score, 199 patients (43%) were in low risk group, 240 (52%) in moderate and 26 (5%) in high risk group. All the patients in high risk group had extended hospital stay and required ICU support. In our study, nine high-risk patients died, highlighting the significant association between high risk group and outcome (p-value <0.001). Elderly (p-value <0.024) and patients diagnosed with dengue or undetermined cause (p-value <0.003 and p-value <0.016) also had high risk score and poor outcome thereby validating the clinical scoring system. No significant relationship (p-value=0.35) between the initial platelet presentation and outcome of the patient was observed. During the course of the study, 135 patients had platelets transfusion and at least 16% of these platelet transfusion could have been avoided if the risk score were calculated in the early phase of treatment development. Conclusion: Total risk score can predict the severity of illness, the need for transfusion and the probable outcome. The scoring system is easily reproducible and can be used at bedside to evaluate patients with febrile thrombocytopenia and help plan its management, including the need for platelet transfusion. This score also helps to prognosticate patients’outcomes to optimise care and survival rate of the patients.
Authors and Affiliations
AG Manoj, K Prabhakar, A Raveesha, BT Hamsa
Keywords
Related Articles
- EP ID EP584120
- DOI 10.7860/JCDR/2019/40420.12860
- Views 105
- Downloads 0
Intra and Inter-Observer Variability of Transformation Zone Assessment in Colposcopy: A Qualitative and Quantitative Study
Introduction: Colposcopy is an important tool in the diagnosis of cervical precancer and early cancer. The assessment of women with abnormal cytology and selection of those who require further therapy or follow up depend...
Role of Primary Diaphragmatic Repair in Traumatic Diaphragmatic Herniation: Case Series and Review of Literature
ABSTRACT Diaphragmatic rupture due to blunt trauma (especially small ruptures) can be effectively treated by primary closure by either laparotomy or laparoscopy with minimal morbidity and mortality. Here, we present a se...
Ball Headed Mini Implant
Letter to Editor
The Role of Epidermal Growth Factor Receptor in Cancer and their Application for New Targeted Cancer Therapy
ABSTRACT Epidermal Growth Factor Receptor (EGFR) has central role in cancer therapy because it causes tumour progression in many cases. The EGFR has seven ligands. Each factor that can block this binding, inhibits the in...
Patient Demographic and Clinician Factors in Antibiotic Prescribing for Upper Respiratory Tract Infections in the Australian Capital Territory from 2006-2015
Introduction: National antibiotic stewardship programs aim to mitigate rising antimicrobial resistance and associated healthcare costs by promoting safe and appropriate antibiotic prescribing. Aim: This study aimed to an...