SYNOPSIS
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore.
“A STUDY OF THROMBOCYTOPENIA IN PATIENTS WITH ACUTE FEBRILE ILLNESSES”
Name of the candidate : Dr. SAYID FAHAD
Guide : Dr. JAYAPRAKASH ALVA
Course and Subject : M.D (General Medicine)
Department of General Medicine,
Father Muller Medical College,
Kankanady, Mangalore – 575002.
August – 2012
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF THE SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Dr. SAYID FAHADP.G. RESIDENT
FATHER MULLER MEDICAL COLLEGE, KANKANADY,
MANGALORE – 575002.
2. / NAME OF THE INSTITUTION / FATHER MULLER MEDICAL COLLEGE, KANKANADY,
MANGALORE – 575002
3. / COURSE OF STUDY AND SUBJECT / M.D. (GENERAL MEDICINE)
4. / DATE OF ADMISSION TO COURSE / 09/04/12
5. / TITLE OF THE TOPIC:
“A STUDY OF THROMBOCYTOPENIA IN PATIENTS WITH ACUTE FEBRILE ILLNESSES.”
6. / BRIEF RESUME OF THE INTENDED WORK.
6.1. Need for the study
Thrombocytopenia is one of the most important haematological manifestation of many infections which may present as acute febrile illness.
As per the WHO (World Health Organisation) case definition criteria,a case of acute febrile illness(AFI) was defined as any individual with fever for atleast 2days or temperature on admission of 38.5C or greater;age more than or equal to 4years with no identified cause of fever,such as diarrhea or pneumonia;or suspected of having typhoid fever or brucellosis,as defined by WHO.
The normal range of platelet count is 1,50,000-4,00,000/μL. Thrombocytopenia is defined as a platelet count below the lower normal limit of <1,50,000/μL.This is due to decreased production,increased destruction (immunogenic and non-immunogenic causes),increased sequestration by the spleen.Infections of varying types (viral,parasitic,bacterial) like dengue,malaria,leptospirosis,typhoid,hiv,miliary tuberculosis and others have been associated with thrombocytopenia.
. The risk of complications like bleeding is inversely proportional to the platelet counts.Identifying clinical features that differentiate any febrile illness with or without thrombocytopenia can help a physician to decide whether to intervene the case further.Severe thrombocytopenia can itself cause complications such as bleeding manifestations presenting as gastrointestinal or intracranial bleed which if not properly intervened can cause death of the patients.
. So this study is intended to be done to find out the incidence of thrombocytopenia in patients with acute febrile illnesses and to correlate the clinical features in them.Meanwhile,an effort is also made to find out the most common cause of thrombocytopenia among these patients.
6.2 REVIEW OF LITERATURE
·A study which included the mortality analysis of patients of acute febrile illness during monsoon in a tertiary care hospital of Mumbai has shown,out of the 2214 patients who had undergone study,82.5% had thrombocytopenia,of which 64.3% had platelets in the range of 20,000-60,000/μL.
· From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of patients were infected with more than one pathogen.
·According to a study done by Ayub treating hospital and National Institute of Medical Sciences(Abottabad),all patients with acute febrile illness without localizing signs were considered for study.Out of the 250 patients, 70% developed thrombocytopenia and 30% were normal.
·Clinic based cross-sectional study conducted at the primary care center of the Hospital University Kebangsaan Malaysia has shown significant comparison between clinical profile of acute febrile illnesses including acute infectious disease and variation in thrombocytopenia levels.
·A study done at the National University Hospital,Singapore which included the patients in intensive care unit has shown evidence of significant thrombocytopenia as a predictor of sepsis and subsequent death. In the subgroup of 53 patients with sepis,22 (42%) developed DIC,31(58%) developed thrombocytopenia,
6.3 OBJECTIVE OF THE STUDY:
·To study the incidence of thrombocytopenia among patients with acute febrile illnesses in our hospital.
·To make an effort to correlate the clinical features of thrombocytopenia in these patients.
·To find out the most common cause of thrombocytopenia among patients with acute febrile illnesses.
7. / MATERIALS AND METHODS
7.1 Source of data:
The data will be collected from patients admitted to Father Muller Medical College Hospital with documented fever of >38.5C and platelet count <1,50,000/μL.
7.2. Method of collection of data:
STUDY DESIGN- This study is a prospective cohort study over a period of one and a half years. A minimum of 200 Patients admitted to the hospital with documented fever of >38.5C and platelet count <1,50,000/μL will be selected using purposive sampling techniques. They are followed from admission till recovery, discharge or death whichever is earlier.
The following investigations will be done in all patients with acute fever.
· Heamoglobin,totalcount,differential count,erythrocyte sedimentation rate,platelet count,peripheral smear,Malarial parasite fluorescent test.
If platelet count is <1,50,000/μL & Malarial parasite fluorescent test is negative,
·IgM Dengue,IgM Leptospirosis,Blood culture will be done.
·Chest Xray,Human immunodeficiency virus,Monospot for Infectious mononucleosis,Bone marrow study will be done only if required.
If diagnosed with a specific disease,subsequent investigations will not be done.Platelet count will be repeated on every third consecutive day of the progression of the illness. Based on the outcome and complications, other tests will also be repeated.
Inclusion Criteria
1.Those admitted in Father Muller Medical College Hospital having fever for atleast 2days or temperature on admission >38.5C.
2..Platelet count <1,50,000/μL.
3.Age more than 15 years.
Exclusion Criteria
1.Platelet count >1,50,000/μL.
2.Age less than 15 years.
3.Pregnant women.
4.On long term medications which causes thrombocytopenia.(Heparin,rifampicin,carbamazepine,acetaminophen etc.)
5.Patients with known chronic illnesses like Systemic lupus erythemetosus,Idiopathic thrombocytopenic purpura,chronic liver diseases,malignancies and autoimmune diseases.
Data Analysis
Data collected will be analyzed by frequency, percentage, mean, standard deviation and chi-square test.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes. Voluntary informed consent will be taken from all the subjects of the study.
7.4 Has ethical clearance been obtained from your institution in case of 7.3
8. / LIST OF REFERENCES
1.Firkin,Penangtion R,Chesterman. Heamorrhagic disorders:capillary and platelet defects.chapter 14, Degruchy’s clinical haematology in medical practice. 5th ed. Wiley-Blackwell; Sept 1989.
2.Tina MP,Clinton KM,Allen LR,Ahamed S,Tharwat I, et al.Concurrent infections in acute febrile illness patients in Egypt. Am J Trop Med Hyg. 2007; 77(2): 390-92.
3.Nair PS, Jain A, Khanduri U, Kumar V. A Study of fever associated with thrombocytopenia. JAPI. Dec 2003; 1151-73.
4.Bajpai, Smrati MD, Bichile, Lata S. Mortality analysis of patients of acute febrile illness during monsoon in a tertiary care hospital of Mumbai. Infectious diseases in clinical practices. Sep 2008; vol 16-issue5: 294-297.
5.Lee KH, Hui KP, Tan WC. Thrombocytopenia in sepsis-A predictor of mortality in intensive care unit. Singapore Med J. 1993; vol 34: 244-46.
6.Tong SF, Noorazah AA, Chin GL, Khairani O. Clinical features of Acute febrile thrombocytopenia among patients attending primary care clinics. Malaysian family physicians. 2006; vol 1(1): 15-18.
7.Mathew RK, Patrick JB, Sok T,Buth S,Chadwick YY. Infectious etiologies of acute febrile illness among patients seeking health care in south-central Cambodia. Am J Trop Med Hyg. Feb 2012; 86(2): 246-53.
9. / SIGNATURE OF THE CANDIDATE -
10. / REMARKS FROM GUIDE- / NIL
11. / NAME AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE / DR.JAYAPRAKASH ALVA, MD
PROFESSOR OF MEDICINE
DEPARTMENT OF GENERAL MEDICINE
FATHER MULLER MEDICAL COLLEGE
KANKANADY, MANGALORE – 575002
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT / DR. NARASIMHA HEGDE , MD
PROFESSOR AND HOD OF MEDICINE
DEPARTMENT OF GENERAL MEDICINE
FATHER MULLER MEDICAL COLLEGE
KANKANADY, MANGALORE – 575002
11.6 SIGNATURE
12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE