Download 6 - Rajiv Gandhi University of Health Sciences

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
Dr. SAYID FAHAD
AND ADDRESS
P.G. RESIDENT
FATHER MULLER
MEDICAL COLLEGE,
KANKANADY,
MANGALORE – 575002.
2.
NAME OF THE INSTITUTION
FATHER MULLER
MEDICAL COLLEGE,
KANKANADY,
MANGALORE – 575002
3.
4.
COURSE OF STUDY A ND
M.D. (GENERAL
SUBJECT
MEDIC INE)
DATE OF ADMISSION TO
09/04/12
COURSE
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 destructio n (immunogenic and non immunogenic causes),increased
sequestration by the
spleen.Infections of varying t ypes (viral,parasitic,bacterial) like
dengue,malaria,leptospirosis,t yphoid,hiv,miliary tuberculosis and
others have been associated with th rombocytopenia.
The risk of complications like bleeding is inversel y 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 properl y intervened can cause death of the patients.
So this study i s 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 p atients.
6.2 REVIEW OF LITERATURE
A study which included the mortalit y anal ysis 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
thrombocyt openia,of which 64.3% had platelets in the range of 20,000 -
60,000/μ L.

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 f ebrile
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 Universit y 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 Universit y 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 thrombocytop enia among
patients with acute febrile illnesses.
7MATERIALS 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
<1,50,000
/μL
documented
fever
of
>38.5C
and
platelet
count
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,M alarial 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 i mmunodeficiency virus,Monospot for Infectious
mononucleosis ,Bone marrow study will be done onl y if required.
If diagnosed with a specific disease,subsequent investigations will not
be done.Platelet count will be repeated on every third consecutive da y
of
the
progression
of
the
illness.
Based
on
the
outcome
and
complications, other tests will also be repeated.
Inclusion Criteri a
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
Platelet count >1,50,000
1.
/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 chron ic illnesses like S ystemic lupus
erythemetosus,Idiopathic thrombocytopenic purpura ,chronic liver
diseases,malignancies and autoimmune diseases.
Data Analysis
Data collected will be anal yzed 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
8
of 7.3
LIST OF REFERENCES
1.Firkin,Penangtion
.
R,Chesterman. Heamorrhagic disorders:capillary and
platelet defects.chapter 14, Degruchy’s clinical haematology in me dical
practice. 5 t h 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. Mortalit y anal ysis of patients of
acute febrile illness during monsoon in a tertiary care hos pital 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
mortalit y in intensive care unit. Singapore Med J. 1993; vol 34: 244 -46.
6.Tong SF, Noor azah AA, Chin GL, Khairani O. Clinical features of
Acute febrile thrombocytopenia among patients attending primary care
clinics. Malaysian famil y 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 DR.JAYAPRAKASH ALVA, MD
OF (IN BLOCK LETTERS)
PROFESSOR OF MEDICINE
11.1 GUIDE
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