DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194157

Thrombocytopenia in children 2 months to 12 years of age admitted in the paediatric intensive care unit of a tertiary care hospital

Jegan Murugan R., Manivannan V.

Abstract


Background: To assess the etiology, clinical profile, complications, outcome and prognosis of children admitted in the paediatric ICU with thrombocytopenia

Methods: This study was done on children admitted to the paediatric ICU of Tirunelveli Medical College Hospital during the period from December 2011 to April 2012. 112 consecutive  patients aged  2 months to 12 years with platelet counts less than 1 lakh were studied.

Results: One in 6.25 children admitted in the paediatric ICU developed thrombocytopenia(15.95%incidence).The commonest age group of presentation of is 6-10 years(47.3%).Infants(45.5%) died more. Dengue(58.8%) was the commonest etiology, followed by enteric fever(11.6%), acute lymphoblastic leukemia (all 4.5%), septicemia(4.5%), plasmodium vivax malaria (2.7%). Leading cause of mortality is dengue shock syndrome(DSS  44.4%). The most common presenting symptom among the study group is fever(95.5%). Abdominal distension and pedal edema were significantly associated with low platelet counts, bleeding manifestations, increased transfusion needs and a  poor outcome. The presence of Altered sensorium, tachycardia, tachypnea, shock, seizures at presentation were all associated with significant bleeding and high mortality. Gastrointestinal bleed(41.07%) was the commonest bleeding manifestation. There was no significant correlation between the exact platelet counts and the bleeding. Children with counts less than 10,000  had a poor outcome.(57.1% mortality). Gall bladder wall edema and pleural effusion in Ultrasound correlate significantly with bleeding.

Conclusions:  Thrombocytopenia is common in sick children in  paediatric ICU and has a definite bearing on prognosis. Infants have poor prognosis and need intensive monitoring. Mortality predictors, if present, need aggressive management. There is no role for prophylactic transfusions, as platelet counts do not correlate with bleeding.


Keywords


Dengue, Mortality predictors, Platelet transfusions, Thrombocytopenia

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References


Cotran Kumar, Robbins. Pathological basis of disease. 8th ed. Philadelphia: W. B. Saunders company; 2010:115.

Strauss R, Hahn E. Thrombocytopenia in patients in the Medical Intensive Care Unit: . Crit Care Med. 2002;30(8):1765-71.

Deborah M. Consolini. Thrombocytopenia in Infants and Children. Pediatr. Rev. 2011;32(4);35-151.

Moreau D, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar JR, Adrie C, et al. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest. 2007 Jun 1;131(6):1735-41.

Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;28(6):1871-6.

Agrawal S, Sachdev A, Gupta D, Chugh K. Platelet counts and outcome in the pediatric intensive care unit. Indian Journal of critical care medicine: peer-reviewed, official publication of Indian Society of Crit Care Medicine. 2008 Jul;12(3):102-8

Muhammad Ali jan .Thrombocytopenia in children. J postgraduate Medical Institute, JPMI. 2004;18(3):353-8.

Roberts I, Murray NA. Neonatal thrombocytopenia: Causes and management. Arch Dis Child Fetal Neonatal Ed. 2003;88(5):359-64.

Rashmi Kumar C, Jyotsana Agarwal G, Nagar R, Jain A. Changing clinical manifestations of dengue infection in north India. dengue bull, 2008;32;118-25.

Mittal H, Faridi MM, Arora SK, Patil R. Clinico hematological profile and platelet trends in children with dengue during 2010 epidemic in north India. The Indian J Pediatr. 2012 Apr 1;79(4):467-71.

Krishnan J, Morrison W. Implications of thrombocytopenia and platelet course on pediatric intensive care unit outcomes., Pediatr Crit Care Med. 2008 Sep;9(5):502-5.

Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and expanded edition. World Health Organization. 2011.

Gamble J, Bethell D, Day NPJ, Loc PP, Phu NH, Gartside IB, et al. Age-related changes in microvascular Permeability: A significant factor in the susceptibility of children to shock?. Clinical Science. 2000;98(2):211-6.

Gomber S, Ramachandran VG, Kumar S, Agarwal KN, Gupta P, Dewan DK. Hematological observations as diagnostic markers in dengue hemorrhagic fever-a reappraisal. Indian Pediatri. 2001 May;38(5):477-81.

Hanafusa S. Southeast Asian J Trop Med Public Health. March 2008:39(2).

Fauziah Md Kassim. Institute for Medical Research, Kuala Lumpur. Use of dengue NS1 antigen for early diagnosis of dengue virus infection;; Southeast Asian J Trop Med Public Health. May 2011:42(3).