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

Abstract

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