Analysis of predictors in outcome of fever with thrombocytopenia of pediatric age upto 12 years


  • Kagitha Pratap Gowd Department of Paediatrics, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Guntur Sai Ram Department of Paediatrics, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Gangadhar B. Belavadi Department of Paediatrics, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India



Bleeding manifestations, Hepatomegaly, Platelet count, Thrombocytopenia, Widal test


Background: It is well recognized that many fetomaternal and neonatal conditions are associated with thrombocytopenia. Study aimed to establish the possible etiology of children presenting with thrombocytopenia.

Methods: The study was carried out in 100 children 1 month-12 years, admitted at department of paediatrics, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India with fever and thrombocytopenia. A thorough history was obtained and a general and systemic examination done. Routine investigations were done in all cases and specific investigations as and when required.

Results: Total 100 cases were studied. Among them, 65% developed only fever, 10% developed fever with bleeding and 25% developed fever with shock. In total admissions 55% of children admitted with warning symptoms including abdominal pain, vomiting, reduced urine output and black colored stools. There is a significant influence of warning symptoms in predicting the outcome of fever with thrombocytopenia. 30% of children admitted with respiratory distress. 30% of children admitted with abdominal distension. 60% children admitted with hepatomegaly. In these children, 20% of them developed fever with shock and 13% of them developed fever with bleeding, 52% children admitted with platelet count less than 1 lakh. In these patients, 19% of them developed fever with shock and 9% of them developed fever with bleeding. 60% had dengue serology positive, 12% had positive Widal test, 8% children had positive urine culture and sensitivity. There was a significant influence of etiology in predicting the morbidity as 15% of children having positive serology for dengue developed fever with shock. 10% of children having positive serology for dengue developed fever with bleeding. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/μl.

Conclusions: The commonest cause of febrile thrombocytopenia in this study was dengue fever in Children. Platelet count was the predictive of bleeding manifestations.


Parthasarathy A, Gupta P, eds. IAP textbook of pediatrics, 5th ed. New Delhi: Jaypee publications; 2013:205.

Jadhav UM, Patkar VS, Kadam NN. Thrombocytopenia in malaria- correlation with severity and type of malaria. J Assoc Physic India. 2004;52:615-8.

World Health Organization and tropical diseases research dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: world health organization; 2009 new edition.

Kshirsagar P, Chauhan S, Samel D. Towards developing a scoring system for febrile thrombocytopenia. J Assoc Physic India 2016;63:14-8.

Strobel M, Muller P, Lamaury I, Rouet F. Dengue fever: a harmful disease in patients with thrombocytopenia? Clinical Infect Dis. 2001;33(4):580-1.

Choudhary MK, Lohani KK, Paswan NK. Study of clinical profile of acute febrile illness with thrombocytopenia. Headache. 2017;5(6):72.

Aroor AR, Saya RP, Sharma A, Venkatesh A, Alva R. Clinical manifestations and predictors of thrombocytopenia in hospitalized adults with dengue fever. North Am J Med Sci. 2015;7(12):547.

Shewale NS. Clinical profile and outcome of children admitted for dengue with warning signs and severe dengue. MedPulse Int J Pediatr. 2017;3(1):23-7.

Jain H. Clinical profile and outcome of dengue fever in hospitalized children of south Rajasthan, India. Int J Contemp Paediatr. 2016; 3(2):546-9.

Gomber S, Ramachandran VG, Kumar S, Agarwal KN, Gupta P, Gupta P, et al. Hematological observations as diagnostic markers in dengue hemorrhagic fever- a reappraisal. Indian Paediatr 2001;38:477-81.

Balasubramanian S, Anandnathan K, Shivbalan S, Datta M, Amalraj E. Cut-off hematocrit value for hemoconcentration in dengue hemorrhagic fever. J Trop Pediatr. 2004;50(2):123-4.

Haas CS, Lehne W, Muck P, Boehm A, Rupp J, Steinhoff J, et al. Acute kidney injury and thrombocytopenic fever- consider the infrequent causes. American J Emerg Med. 2013;31(2):441-e5.

Walid SF, Sanusi S, Zawawi MM, Ali RA. A comparison of the pattern of liver involvement in dengue hemorrhagic fever with classic dengue fever. Southeast Asian J Trop Medic Public Health. 2000;31(2):259-63.

Fariz-Safhan MN, Tee HP, Abu Dzarr GA, Sapari S, Lee YY. Bleeding outcome during a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia: a prospective study. Trop Biomed. 2014;31(2):270-80.

Chen CC, Lee IK, Liu JW, Huang SY, Wang L. Utility of C-reactive protein levels for early prediction of dengue severity in adults. BioMed Res Int. 2015;2015.






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