Prevalence Of Thrombocytopenia Research Articles

Assessment of Platelet Numbers and Prevalence of Thrombocytopenia among Children with Severe Malaria at a Tertiary Teaching Hospital

Background: Thrombocytopenia plays an important role in the diagnosis of malaria in most countries because of the rapid decrease of platelets during malaria onset and also in severe forms of the disease. The study sought to assess platelet numbers and determine the prevalence of malarial thrombocytopenia among children with febrile malaria at the Korle-Bu Teaching Hospital (KBTH). Methodology: It was a cross-sectional study carried out in the Department of Child Health and the Polyclinic of KBTH from April to July 2018. A total of 100 children aged from 1 to 12 years who tested malaria positive for both thick and thin blood film and Rapid Diagnostic Tests (RDTs) were recruited into the study. Venous blood sample was obtained from the children and analyzed for platelet count using a haematology auto analyzer. Parasite speciation and quantification was used to classify the disease into mild, moderate and severe, and platelet numbers were also categorized into low, normal and high. Data obtained was then analyzed for prevalence of malarial thrombocytopenia in severe malaria. Results: The total studied participants were 100, 61 (61%) were males whiles 39 (39%) were females. Both severe malaria and thrombocytopenia were mostly seen in children less than 5 years of age and the males recorded more thrombocytopenia (66%) and normal platelet numbers 34 (64.2%) than the females. There was a significant higher percentage of malaria children with thrombocytosis being females (64%) as compared to those being males (36%). 53 (53%) children had normal platelet numbers, 33 (33%) had thrombocytopenia, and 14 (14%) had thrombocytosis. The prevalence of uncomplicated malaria and complicated malaria were 80% and 20% respectively. The overall prevalence of thrombocytopenia was 33%, and the prevalence of thrombocytopenia in uncomplicated and severe malaria was 18.8% and 90% respectively. The prevalence of malaria types among children with thrombocytopenia was assessed. Out of the 33 (33%) patients who had thrombocytopenia, 15 (45.5%) of them had uncomplicated malaria and 18 (54.5%) of them had complicated or severe malaria. No child was found to have thrombocytosis during complicated malaria. Conclusion: The study indicates a significant higher prevalence of thrombocytopenia in severe malaria among children at the Korle-Bu Teaching Hospital, and this could be used as a useful indicator to investigate malaria or as a diagnostic clue for malaria in children.

Prevalence of Thrombocytopenia Among Pregnant Women in Tripoli Region /Libya

Thrombocytopenia is the definition of a condition in which the number of platelets is less than 150,000 / ml, and this deficiency may be the result of a lack of platelet production in the bone marrow or an increase in their breakdown in the connective tissue. This condition is common in pregnant women, with a global prevalence of about 7%. This study aims to find out the prevalence of this condition among pregnant women in the Tripoli area. A cross-sectional study design was used to assess the prevalence of thrombocytopenia among pregnant women who have visited the obstetrical ward department of obstetrics and gynecology in Al jalaa Hospital, Tripoli from January to April 2021. 1700 pregnant women have been included in the study during their follow-up in Al jalaa hospital of gynecology and obstetrics at the time of the study. 2 milliliters of venous blood were collected under aseptic conditions and transferred into (EDTA) tubes. The complete blood cell counts were determined using a Sysmex analyzer. Sony computer CORE i7 was used, bivariable statistical analysis was carried on using Microsoft office excel to evaluate the effect of an independent variable over the dependent variable. Results shows that 18% of pregnant women were thrombocytopenic; this thrombocytopenia was increased with age, upon the classification and severity of thrombocytopenia 78.5% were mild, and 21.5% were moderate thrombocytopenic with no sever cases. <i>Conclusion:</i> It can be concluded that thrombocytopenia disorders in pregnancy are very common in the Tripoli region, the prevalence of thrombocytopenia increased with the increase in the gestational age to reach the maximum at the third trimester of gestation.

Prevalence of thrombocytopenia in Parturient: Experience in Tertiary Care Center

Prevalence of thrombocytopenia in Parturient: Experience in Tertiary Care Center

Pre-procedural platelet transfusion thresholds in hospitalised children - Protocol for a scoping review.

Thrombocytopenia is a common condition in hospitalised critically ill children and most platelet transfusions are given as prophylaxis to non-bleeding children prior to invasive procedures such as central venous catheterisation and lumbar puncture. Platelet transfusion may reduce bleeding complications but have also been associated with potential adverse effects and variation in clinical practice exist. To direct future research, we aim to assess the current evidence regarding prophylactic platelet transfusion prior to procedures in hospitalised thrombocytopenic children. We will conduct a scoping review of all study designs in accordance with the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement. We will include studies on hospitalised children undergoing invasive procedures where the prevalence of thrombocytopenia and the predefined outcome measures, including bleeding, transfusion-related adverse events and use of blood products and life support are reported. We will provide descriptive analyses of the included studies/trials and the quality of evidence will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The outlined scoping review will provide an overview on the benefits and harms of prophylactic platelet transfusion prior to invasive procedures in thrombocytopenic hospitalised children.

COVID-19-Associated Coagulopathy: Safety and Efficacy of Prophylactic Anticoagulation Therapy in Hospitalized Adults with COVID-19

Background:COVID-19-associated coagulopathy increases mortality in patients with COVID-19 infection. The International Society of Thrombosis and Hemostasis (ISTH) has published a guidance document recommending thromboprophylaxis with low-molecular weight heparin (LMWH) for all hospitalized patients with COVID-19. Despite standard dose LMWH thromboprophylaxis, arterial and venous thrombotic events occur in up to 30-40% of COVID-19 patients admitted to the intensive care unit (ICU). It is not known if patients with coagulopathy from COVID-19 benefit from higher levels of prophylactic anticoagulation therapy. No data exist regarding the comparative safety or efficacy of intermediate dose versus standard prophylactic dose LMWH.Study Design and Methods:This is a multi-center, randomized, open-label study (NCT04360824) comparing standard prophylactic dose enoxaparin (40 mg SC daily if BMI < 30 kg/m2; 30 mg SC twice daily or 40 mg SC twice daily if BMI ≥ 30 kg/m2) versus intermediate-weight adjusted dose enoxaparin (1 mg/kg SC daily if BMI < 30 kg/m2 or 0.5 mg/kg SC twice daily if BMI ≥ 30 kg/m2) in hospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are either admitted to an intensive care unit or have a modified ISTH Overt DIC score ≥ 3.Objectives:The primary endpoint is to compare all-cause 30-day mortality of patients treated with standard prophylactic dose versus intermediate-dose enoxaparin. The secondary endpoints are to determine whether the use of standard prophylactic dose versus intermediate dose enoxaparin impacts major bleeding, arterial thrombosis, venous thrombosis, time to intubation or transfusion of blood products. The exploratory endpoints are to determine the effects of SARS-CoV-2 infection on laboratory coagulation parameters to better understand the mechanism of COVID-19 coagulopathy compared to healthy control subjects; parameters include citrullinated histone H3 (H3Cit), a component of neutrophil extracellular traps. The null hypothesis is that intermediate dose enoxaparin (intervention arm) will have a mortality rate that is not less than standard prophylactic dose enoxaparin (standard of care arm). Assuming a true margin of 20%, a sample size of 82 patients in each arm of the study is required to have 80% power when testing for a difference.Baseline Data:Three centers are currently enrolling patients. As of August 1, 2020, we have enrolled 52 patients (28 males and 24 females) with a median age of 61 years (range 24-80). 51% were Caucasian, 36% Hispanic, and 16% other ethnicities. Median BMI was 31 kg/m2 (range 20-52). Baseline D-Dimer was elevated in 95% of participants with a median of 2.23 mg/mL (range 0.39-40.32). The majority of participants had normal baseline PT, PTT, and platelet levels. All patients had fibrinogen levels over 100 mg/dL with a median of 607 mg/dL. Plasma H3Cit was elevated significantly in patients with COVID-19 (n = 21) vs healthy control subjects (n = 10) (6.48 vs 1.09 ng/mL, P = 0.001).Conclusion:Baseline data for the first 52 patients enrolled confirm the presence of multiple risk factors for thrombosis such as elevated BMI, D dimer, and plasma markers of neutrophil extracellular traps. In contrast to initial reports from China, the prevalence of thrombocytopenia and hypofibrinogenemia was very low in our cohort. Hispanics represented 36% of our study population, compared with 19% of overall COVID-19 infections in the region, suggesting a higher severity of illness in this subpopulation. The enrollment of this trial is ongoing with the addition of sites that have larger African American populations. As safety and efficacy data mature, this study will help clarify the optimum dose of prophylactic enoxaparin to prevent COVID-19 associated coagulopathy.DisclosuresNo relevant conflicts of interest to declare.

Indeterminate Serotonin Release Assays Are Associated with a High Mortality Rate

INTRODUCTION: The serotonin release assay (SRA) is considered the gold standard for diagnosis of heparin-induced thrombocytopenia (HIT). While the SRA holds high sensitivity and specificity when results are definitive, up to 10% of samples from patients with suspected HIT yield "indeterminate" results. In classic HIT, the SRA typically reveals high levels of serotonin release when serum is mixed with low concentrations of heparin and low levels of serotonin release when serum is mixed with high concentrations of heparin. Results are considered "indeterminate" when high levels of serotonin release are seen at both low and high concentrations of heparin, indicating a failure of high-dose heparin to saturate the heparin binding sites of PF4 molecules and inhibit platelet activation. Explanations for indeterminate assays include the presence of heparin-binding proteins that interfere with the assay, high titers of HLA class I alloantibodies, or immune complexes. Since the diagnosis of HIT carries such significance and has so many ramifications, an indeterminate SRA may leave therapeutic indecision. The etiologies, platelet trends, clinical course and outcomes of patients that receive indeterminate SRA results are not well-understood. We conducted a retrospective review of 2,056 patients that underwent SRA testing as part of their evaluation for HIT. METHODS: Using the electronic medical record data extraction software Clinical Looking Glass, we identified patients that underwent SRA testing between 1/1/2014 and 12/31/2018. SRA results were considered "indeterminate" when serotonin release exceeded 19% at all heparin dilutions (0.1 U/mL, 0.5 U/mL and 10 U/mL). We conducted a retrospective chart review to study the clinical course among patients who had "indeterminate" SRA results, the trends in platelet count, the timing of platelet drops and the physician response to this result. Statistical analysis was performed using chi-square testing for categorical variables. RESULTS: We identified 2,056 patients that underwent SRA testing between 2014 and 2019. Of these, 90 patients (4.4%) had "positive" SRA results and 1,814 patients (88.2%) had "negative" SRA results. Among the 152 patients (7.4%) with "indeterminate" SRA results, the mean 4T score was just 2.9, corresponding to a HIT probability of &amp;lt;5%. One-hundred and twenty of these 152 patients (78.9%) had heparin-PF4 antibody testing with optical densities below 0.60 OD, while only 4 of 152 patients (2.6%) had optical densities above 2.00 OD. Seventy eight of 152 patients (51.3%) either continued or were re-exposed to heparin after the indeterminate SRA result, and in 71 of 78 cases (91.0%), the platelet count stabilized or improved despite heparin exposure. In the remaining 7 cases, no acute VTE were found and no diagnosis of HIT was made. Four of the 71 patients (5.6%) that continued or were re-exposed to heparin were noted to have an acute VTE. A significantly higher portion of patients with an indeterminate SRA died during admission compared to those with a positive or negative SRA (49.3% vs. 21.1% and 27.2%, p &amp;lt;2.4 x10-10). The prevalence of thrombocytopenia &amp;lt;50,000 was substantially higher in patients with an indeterminate or positive SRA, compared to those with a negative SRA (39.5% and 40.0% vs. 27.5%, p &amp;lt;4.0 x 10-4). Re-exposure or continuation of heparin did not affect mortality; patients that were given heparin after an indeterminate SRA had a 47.4% mortality, compared to 51.4% in those given no more heparin (p = 0.63). Table 1 summarizes these findings. CONCLUSIONS: This is the largest study to date looking at patients with indeterminate SRA testing results, in which platelets exhibit high levels of serotonin release at both low and high heparin concentrations. Our data suggest 1) the majority of patients with indeterminate SRAs likely did not have HIT, 2) as evidenced by the low 4T scores and heparin-PF4 antibody levels, an indeterminate SRA suggests thrombocytopenia related to in-vivo platelet activation, and 3) an indeterminate SRA is associated with increased mortality. SRA results warrant a case-by-case assessment of the clinical picture in order to avoid unnecessary cessation of heparin products. Further studies exploring the mechanism leading to high serotonin release at both low and high heparin concentrations, causing an "indeterminate" SRA result, are warranted. Disclosures No relevant conflicts of interest to declare.

Prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary and quaternary centre in KwaZulu-Natal.

BackgroundThrombocytopenia is a common haematological disorder, characterised by platelet counts below 150 × 109/L. The aetiology of thrombocytopenia is multifactorial; notably, in a misdiagnosis this condition may be due to pre-analytical laboratory artefacts. Knowledge about the common aetiology of thrombocytopenia will assist clinicians in decision-making and interpretation of laboratory tests and this may lead to prompt, adequate patient management and cost-saving measures.ObjectiveThis study determined the prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary or quaternary laboratory in Durban, KwaZulu-Natal, South Africa.MethodsWe conducted a retrospective study at the Inkosi Albert Luthuli Central Hospital haematology laboratory between October 2015 and April 2016. A total of 2076 full blood count results with a platelet count of less than 100 × 109/L were retrieved from the Inkosi Albert Luthuli Academic Hospital database. Laboratory data were extracted and matched with clinical data and used to identify the potential aetiology of thrombocytopenia.ResultsThe prevalence of thrombocytopenia was 14.9% within the selected study period. The haematology or oncology wards and clinic accounted for 55.2% of thrombocytopenia cases, whereas the adult and paediatric intensive care units accounted for 29.3%. Notably, 15.5% of thrombocytopenia cases were reported in non-haematology wards and clinics. The most common cause of thrombocytopenia was chemotherapy which accounted for 38.5% of all causes.ConclusionIn our tertiary and quaternary setting, thrombocytopenia in adults was most common in patients admitted to haematology and oncology wards. Moreover, chemotherapy-induced thrombocytopenia accounted for more than a third of all these cases.

Anemia and thrombocytopenia in people living with HIV/AIDS: a narrative literature review.

Hematologic changes are frequent complications in people living with HIV/AIDS (PLWHA). Anemia and thrombocytopenia are the most frequent multifactorial hematologic abnormalities and are associated with a low quality of life and high death rates. This study aims to describe the prevalence of anemia and thrombocytopenia in PLWHA and to identify the main clinical characteristics that aggravate these conditions in studies published in the last 10 y. A comprehensive search was performed on the PUBMED database, using the terms ‘HIV infection and anemia’ and ‘HIV infection and thrombocytopenia’. Additional searches were made in the reference lists of articles covering the theme. The selected studies reported an overall prevalence of anemia from 7.2% to 84% and of thrombocytopenia from 4.5% to 26.2%. The prevalence of thrombocytopenia and anemia were aggravated by a CD4+ T lymphocyte count of <200 cells/μL, increased viral load and coinfections or opportunistic infections. Antiviral therapy (ART) shows a beneficial effect, reducing the frequencies of thrombocytopenia and anemia, except in a zidovudine-based ART regimen, which worsens the anemic condition. Because anemia and thrombocytopenia are treatable comorbidities associated with increased mortality among PLWHA, physicians should monitor these risk factors in order to establish better interventions and reduce morbidity and mortality in PLWHA.

A clinical study of spectrum of low platelet count to establish etiology, diagnosis, complications and prognosis in newborns admitted in Al-Ameen medical college hospital NICU, Bijapur, Karnataka, India

Background: In the newborn low platelet count is a common finding in both preterm and term newborn. It has been estimated that as many as 22% of all new borns admitted to NICU develop low platelet counts. A platelet count of less than 150,000/mL is defined as thrombocytopenia irrespective of the age of the individual.Methods: All the neonates underwent necessary blood investigations like Complete blood counts, (including platelet counts, HB estimation, Red cell indices and PCV), Capsular Polysaccharide - reactive protein. (CRP), Peripheral Smear study, Blood culture, BT, CT, PT, aPPT, Anti-platelet Antibodies.Results: The prevalence of thrombocytopenia in our study was 28%. The proportion of severe thrombocytopenia among the neonatal thrombocytopenia, 11.2% in our study.Conclusions: It can be concluded that thrombocytopenia is very much common in among our NICU admissions. Septicemia is its most important and most common cause.

HEMATOLOGICAL PROFILE IN PATIENTS OF CHRONIC KIDNEY DISEASE WITH ITS SEVERITY IN A TERTIARY CARE HOSPITAL, NORTH ODISHA

Objective: Efforts can be made to normalize the hematological parameters and slow the progress of the disease so that the morbidity and mortality in these patients with chronic kidney disease could be effectively reduced.&#x0D; Methods: The observational study was carried out in the Department of General Medicine, Pandit Raghunath Murmu Medical College Hospital, Baripada, between May 2018 and January 2019. Two hundred seventy patients of chronic kidney disease (CKD) above 15 years of age, satisfying the inclusion and exclusion criteria, were included in the study.&#x0D; Results: In our study, 179 (66.30%) were male, and 91 (33.70%) were female with M:F of 1.97:1. The average age of the patients in the study was 55.72±12.77 years. About 42.59 % (115) of the patients were between 46 and 60 years of age. About 35.56% of CKD cases had determined etiology and, 64.44% of cases had unknown etiology. Hemoglobin, RBC, and packed cell volume were significantly lower in the patients with CKD compared to the controls (p=0.0001), and RDW was considerably higher in the patients with CKD compared to the controls (p=0.0001). Microcytic anemia was the most prevalent type of anemia. There was a hugely significant association between the prevalence of thrombocytopenia and the severity of CKD (p=0.006).&#x0D; Conclusion: This study concluded that patients with CKD show abnormal hematological parameters. Evaluation of hematological parameters in these patients helps in classifying the type of anemia, aids in choosing the correct treatment modalities, and decreases mortality.

Clinical epidemiology of paediatric febrile and afebrile in-patients and their association with thrombocytopenia

Background: Fever is one of the commonest and thrombocytopenia is one of the common clinical problems in children. The current study was done with the aim to identify the frequency and the etiology of thrombocytopenia in febrile children. This study was planned to identify epidemiological observations associated with pediatric fever and with febrile thrombocytopenia children, in this area among hospitalized children.Methods: A sample of 530 children of age 6 months to 18 years were studied. Febrile children were taken as cases (n=268) and afebrile children as controls (n=262). Demographic, clinical and laboratory characteristics were measured and compared between the cases and controls.Results: Significant proportion of 1-3 years age group of children belong to febrile group compared to afebrile group. There is no significant difference in the gender, region, WFH or BMI, WFA, HFA between febrile and afebrile children. No significant difference in pulse rate, respiratory rate; TLC, ALC, ANC, Hb; Widal test or CRP was noted between pyrexial and apyrexial children. The median platelet count, in the pyrexial group is significantly lower than that of apyrexial group. Prevalence of thrombocytopenia in pyrexial group is significantly more than that observed in apyrexial group. The commonest illness in pyrexial group is non-bacterial-probable viral illness (59.7%). In the apyrexial group the common diseases are neurological (36.6%) disorders.Conclusions: Prevalence of thrombocytopenia is 11.45% in febrile children and in afebrile children it is 2.38%. In this study, viral infections and neurological disorders are the commonest etiology in febrile group and afebrile children respectively.

Thrombocytopenia; Frequency and Association at the Time of Diagnosis in Dengue Fever, Peshawar

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACT:&#x0D; OBJECTIVES: To determine the frequency of thrombocytopenia in dengue fever at the time of diagnosis and to see its association with age and gender.&#x0D; METHODOLOGY: It was a descriptive retrospective study of dengue cases admitted to the Medical Unit of Naseer Teaching Hospital Peshawar during the 2019 outbreak was performed. Only confirmed dengue by serology (IgM) or dengue NS1 (Non-Specific Antigen 1) by Immunochromatographic Technique (ICT) cases were analysed. Complete Blood Count (CBC) was done for all the cases on admission and prevalence of thrombocytopenia on admission was extracted from the records. SPSS version 23 was used to analyse the data and to calculate Odds Ratio of a gender or age group to have thrombocytopenia at the presentation of dengue fever.&#x0D; RESULTS: A total of 69 confirmed dengue cases were admitted in Naseer Teaching Hospital in the 2019 outbreak. Out of these 69 cases, 51 (73.9%) were males and 18 (26.1%) were females. The ages of these patients ranged from 10-58 years. Fifty-one (51) patients were more than 20 years of age and eighteen (18) were 20 years or less. Thrombocytopenia (platelet count&lt;150,000×109/L) was present in 57 (82.6%) patients. Patients older than 20 years of age were more likely to have thrombocytopenia at presentation of dengue fever OR=16, (p=0.0003), whereas difference amongst genders in this regard was not statistically significant OR=1.07, (p=0.09).&#x0D; CONCLUSION: There is a high frequency of thrombocytopenia (82.6%) in early dengue fever. Patients older than 20 years are more likely to have thrombocytopenia in early dengue fever.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; KEYWORDS: Dengue Fever, Acute Febrile Illness, Thrombocytopenia

Prevalence of Thrombocytopenia during Pregnancy and Its Effect on Pregnancy and Neonatal Outcome

Prevalence of Thrombocytopenia during Pregnancy and Its Effect on Pregnancy and Neonatal Outcome

Thrombocytopenia in pregnancy; prevalence, causes and fetomaternal outcome

Background: Thrombocytopenia is seen in up to 12% of pregnancies. Most cases are due to benign gestational thrombocytopenia and have no adverse effects. It can, however, be due to underlying serious causes and can lead to adverse maternal and perinatal consequences. Objective: To discover the prevalence and causes of thrombocytopenia and the impact of its severity on feto-maternal outcome. Materials and Methods: This is a retrospective comparative study. Thrombocytopenia was defined as platelet count less than 150×109/L detected any time after 24 weeks gestation and averaged during prenatal visits. All thrombocytopenic pregnant patients who completed 24 weeks of gestation were included. Cases were then divided into mild (group 1, platelet count between 70 and 150×109/L) and moderate to severe (group 2, platelet count less than 70×109/L) thrombocytopenia. Results: The prevalence of thrombocytopenia in pregnant women was 7.20%. Benign gestational thrombocytopenia (BGT) accounted for 78.53%, with idiopathic (immune) thrombocytopenic purpura (ITP) accounting for 1.93%, pre-eclamptic toxaemia (PET)/HELLP syndrome accounting for 7.41%, drugs 7.23%, systemic lupus erythematosus (SLE) with or without antiphospholipid antibodies (APA) 0.84%, and various maternal diseases 4.04%. Compared with mild thrombocytopenic pregnant women (group 1), moderate to severe thrombocytopenic women (group 2) were at a significantly greater risk of caesarean section, antepartum hemorrhage (APH), postpartum hemorrhage (PPH), wound haematoma, intrauterine fetal death (IUFD), preterm delivery, and intrauterine growth restriction (IUGR). Conclusion: Thrombocytopenia is prevalent in this obstetric population with various obstetric and nonobstetric causes. The consequences of thrombocytopenia in pregnancy are mostly benign, but moderate to severe thrombocytopenia was associated with adverse obstetric and perinatal outcomes. This was due to the nature and severity of the underling maternal diseases and their medication. The authors recommend studying prospectively each of these thrombocytopenia-induced diseases in pregnancy.

Association of Thrombocytopenia and Mortality in Critically ill Children Admitted to PICU in Tertiary Hospital In Biratnagar

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality.&#x0D; Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children.&#x0D; Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome.&#x0D; Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=&lt;0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU.&#x0D; Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

The global prevalence of thrombocytopenia among pregnant women: A systematic review and meta-analysis

Background: Thrombocytopenia (TCP) is a common disorder during pregnancy. Its prevalence among pregnant women is four times greater than nonpregnant women. Objectives: This study aimed at determining the global prevalence of TCP among pregnant women. Methods: This systematic review and meta-analysis was conducted in 2018. The PubMed, Scopus, Google Scholar, Magiran, and IranMedex databases were searched using the following key words: “TCP,” “pregnancy,” “pregnant,” “pregnant women,” “gestational,” and “platelets.” The titles and the abstracts of the retrieved studies were screened to identify potentially relevant studies. Articles were included if they were the reports of original researches, included data on the prevalence of TCP among pregnant women, were in English or Persian, and had been published from January 1, 2000 to September 1, 2018. Eligible studies were appraised using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Finally, a data collection form was used to extract data. The overall prevalence of TCP among pregnant women was estimated using meta-analysis and the Comprehensive Meta-Analysis Software. Heterogeneity was evaluated through the Chi-square test and the I2 statistic, and funnel plot was used to evaluate the possibility of publication bias. Results: Among 1592 studies retrieved during literature search, sixteen were included in meta-analysis. The overall prevalence of TCP among pregnant women based on the random effects model was 8.4% (95% confidence interval: 6.9%–10.1%). The lowest TCP prevalence was 4.3% in Taiwan, while the highest prevalence was 15.3% in Ghana. Gestational TCP was the most common cause of TCP among pregnant women. Conclusion: With a global prevalence of 8.4%, TCP in pregnancy affects around one-tenth of pregnant women in the world. Thus, timely diagnostic, preventive, and therapeutic measures are needed to effectively manage TCP in pregnancy.

DENGUE FEVER AND THROMBOCYTOPENIA – A PROSPECTIVE OBSERVATIONAL STUDY AT TERTIARY CARE CENTRE

Background: Dengue fever is one of the commonest diseases in tropical countries and carries significant morbidity and mortality. Thrombocytopenia (low platelets) is one of the very common manifestations in case of dengue infection. Platelet transfusion in dengue always remains controversial. Objective: Present study was conducted to study precise criteria and transfusion trigger for platelet transfusion in our set-up. Materials and Methods: This study was conducted on 112 serologically antibody positive confirmed dengue patients admitted in a Hospital, Powai, Mumbai, between 1st of August to 30th October 2017. The age groups of the included patients were within 20-50 years and did not have any co morbidity and were diagnosed at OPD. Indication for hospitalization includes high grade fever (>101° F) and platelet counts less than 100,000 along with other viral prodromal symptoms. Clinical data, reports of laboratory investigations, platelets requirements and data obtained from daily follow-up and record sheets were analyzed. Results: In the serologically positive confirmed cases, the prevalence of thrombocytopenia (count <100,000/mm3) was 97% on admission and there was no bleeding recorded in any patient. Out of 112 serologically confirmed dengue cases, only 1 (<1%) patient of dengue received platelet transfusion whose platelet counts were <7000/mm3 and he had petechiae all over the body. Total 9 patients had platelet count <10000/mm3 (8.03%), 28 (25%) patients had platelet count <20,000/mm3, 52 (46%) had a platelet counts <40,000/mm3 while total 79 (70.53%) patients had platelet counts <50,000/mm3. In the study population, 28 (25%) patients had platelet count <20,000/mm3 and 9 (8.03%) patients had platelets count <10000/mm3, only 1 patient had petechiae; hence platelet transfusion was given. For all other patients who had platelet counts <20,000/mm3, their clinical parameters were monitored strictly and frequent manual platelet counts were done. These patients were not given any transfusion. Conclusion: This study suggests that bleeding due to thrombocytopenia in case of dengue fever is not a common occurrence especially, in otherwise healthy adult or middle aged patients. Those with no or minimum co morbidities and strict monitoring of symptoms are required to preserve the resources and to avoid unwanted platelet transfusions. Platelet count should not be a bench mark for someone to transfuse the platelet. Signs of bleeding, other co-morbid factors and clinical parameters should be taken in to consideration before starting platelet transfusions.

Profiles of hematological parameters in Plasmodium falciparum and Plasmodium vivax malaria patients attending Tercha General Hospital, Dawuro Zone, South Ethiopia.

BackgroundMalaria is a major health problem in the tropics, with 300–500 million cases and 1.1–2.7 million deaths occurring annually. The hematological alterations associated with malaria infection may vary depending on: level of malaria endemicity, background hemoglobinopathy, malaria immunity, host genetic factors, and parasite strain variations.ObjectiveThe aim of the study was to determine the profiles of hematologic parameters in Plasmodium falciparum and Plasmodium vivax malaria infections at Tercha General Hospital, Dawuro Zone, South Ethiopia.MethodologyA total of 340 study participants were included in the study, out of which 170 were malaria cases, and the remaining 170 were malaria negatives. An institution-based cross-sectional study was conducted. Malaria diagnosis was based on thick and thin blood films microscopy. Hematological parameters were determined by using an automated, CELL-DYN 1800 hematology analyzer. Malaria parasite density was determined by counting the asexual parasites against 200 WBCs, and then calculated by using the standard formula. The diagnostic accuracy of hematological parameters was measured by computing sensitivity, specificity, and likelihood ratios.ResultsThe mean values of Hgb, Hct, platelet, WBC, RBC, and lymphocyte were significantly lower in malaria patients than malaria negatives. The prevalence of thrombocytopenia and anemia in malaria patients was 84% and 67%, respectively. There was an inverse correlation between P. falciparum and P. vivax parasite density and lymphocyte count, as well as platelet count.Conclusion and recommendationThrombocytopenia and anemia were the two common hematological abnormalities observed in malaria cases. The platelet count during malaria infection was inversely correlated with the asexual stage parasite density. Patients with acute febrile illness having thrombocytopenia should alert the treating physician about the possibility of malaria infection. Malaria patients should be checked for the presence of hematological abnormalities such as anemia and have to be managed for those abnormalities.

Nonalcoholic Fatty Liver Disease and Thrombocytopenia III: Its Association With Insulin Resistance.

Thrombocytopenia (less than 100 × 109/L platelets) presents in around one quarter of patients with nonalcoholic fatty liver disease (NAFLD), the hepatic component of insulin resistance (IR). It is unknown whether IR, by itself, associates with thrombocytopenia. Persons with NAFLD and/or IR were prospectively accrued in the study after February 2018. Insulin resistance was defined by assessing α hydroxybutyrate, lynoleoyl glycerolphosphocoline, oleic acid, and insulin (Quantose IR), whereas the presence of NAFLD was defined by serologic determinations (Fibromax) and liver transient elastography (Fibroscan). In 78 patients with NAFLD, thrombocytopenia was identified in 22 (28%), whereas in 19 persons with IR, 14 (73%) were found to have NAFLD. In persons with IR + NAFLD, thrombocytopenia presented in 9 (64%). In the subset of patients with IR, the prevalence of thrombocytopenia was 52%. There was only 1 patient with IR/without NAFLD who displayed thrombocytopenia. Significant statistical association between NAFLD and thrombocytopenia was found (odds ratio [OR]: = 13, confidence interval [CI]: 1.5-162, P = .05), whereas there was no association between IR and thrombocytopenia (OR = 0.38, CI: 0.06-2.3, P = .61). Insulin resistance, by itself, was not found to be associated with diminished platelet counts. The presence of NAFLD, one of the consequences of IR, seems to be required to lead into thrombocytopenia.

An audit of the diagnostic accuracy of rotational thromboelastometry for the identification of hypofibrinogenaemia and thrombocytopenia during cardiopulmonary bypass.

We audited the diagnostic accuracy of ROTEM® (TEM Innovations, GmbH, Munich, Germany) measurements of hypofibrinogenaemia (fibrinogen <1.5 g/l) and thrombocytopenia (platelet count <100 x 10⁹/l) in 200 adult non-transplant patients during cardiopulmonary bypass (CPB). Blood samples were obtained for FIBTEM (assay for the fibrin part of the clot), PLTEM (calculated platelet-specific component), and laboratory measurements simultaneously. Our thresholds for FIBTEM and PLTEM were A10 (clot firmness 10 minutes after clotting time) ≤8 mm, and <35 mm respectively. We also calculated the accuracy of smaller thresholds and earlier indices. We found that FIBTEM A10 ≤8 mm had low sensitivity (0.62) for hypofibrinogenaemia. With the 13% hypofibrinogenaemia prevalence in our sample, the positive predictive value (PPV) was 0.47. In contrast, FIBTEM A10 ≤8 mm had higher specificity (0.90) (negative predictive value [NPV] 0.94). Of the other FIBTEM values analysed, only A5 ≤6 mm had similar or superior accuracy. The PLTEM results were less encouraging (sensitivity 0.81, specificity 0.62). With our prevalence of thrombocytopenia (also 13%), the PPV was only 0.24. However, the NPV was high (0.96). Of the other PLTEM values analysed, only A5 <25 mm had similar or superior accuracy. These findings indicate that during CPB FIBTEM A10 ≤8 mm and PLTEM A10 <35 mm have greater accuracy in identifying the absence of hypofibrinogenaemia and thrombocytopenia respectively than their presence. On the basis of these results we would be reassured by FIBTEM A10 values >8 mm and PLTEM A10 values ≥35 mm, but would continue to use laboratory measurements for confirmation. We would not use FIBTEM A10 ≤8 mm or PLTEM A10 <35 mm values alone to guide replacement therapy unless clinical conditions warranted an immediate decision before laboratory measurements were available.