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 83
- Downloads 0
Congenital Ectropion Uveae with Glaucoma: A Case Report
Congenital Ectropion Uveae (CEU) is a rare anomaly characterised by ectropion uveae, iris hypoplasia, iridotrabecular dysgenesis and glaucoma. Hyperplasia of the iris pigment epithelium and its apparent spread over the a...
Comparison of Different Dosing Protocols of Anti-Snake Venom (ASV) in Snake Bite Cases
Introduction: Considering the cost of Anti-Snake Venom (ASV) and irregularity in its supply, there is often a need to curtail doses of ASV, despite guidelines for management of snake bite. During June 2013 to September 2...
Periodontally Accelerated Osteogenic Orthodontics (PAOO) Assisted Management of Palatally Impacted Canine with Five Years Follow Up
Periodontally Accelerated Osteogenic Orthodontics (PAOO), a patented technique by the Wilcko brothers has become very popular in reducing the treatment time in Orthodontics. A 17-year-old male patient presented to the De...
Pattern of Usage of TB Diagnostic Procedures in Private Sector across Three Cities of a Central Indian State
Introduction: Despite the preference of Revised National Tuberculosis Control Program (RNTCP) for sputum microscopy, a variety of Tuberclosis (TB) diagnostic procedures are being used in private sector for the diagnosis...
Versatility of Transconjunctival Approach in Maxillofacial Trauma-A Prospective Study and Review of Literature
ABSTRACT Introduction: Maxillofacial injuries are multiple and complex type of injuries which require multi-specialty management. Maxillofacial trauma can involve the skin, soft tissues, as well as bones resulting in sin...