Towards Developing a Scoring System for Febrile Thrombocytopenia.

BACKGROUND The authors wished to develop a scoring system for evaluating patients presenting with febrile thrombocytopenia for risk stratification, predicting patient outcome and optimization of care especially in resource poor countries. OBJECTIVE 1. To decide a protocol in the management of patients with fever and thrombocytopenia. 2. To develop screening or therapeutic guidelines (early warning score-EWS) in febrile thrombocytopenic patients and decide about therapeutic interventions. METHODS 1. To decide a protocol in the management of patients with fever and thrombocytopenia. 2. To develop screening or therapeutic guidelines (early warning score-EWS) in febrile thrombocytopenic patients and decide about therapeutic interventions. DESIGN Retrospective study and development of a bedside scoring system based on Platelet Count, Temperature, Respiratory Rate, Blood Pressure. Pulse, CNS, Respiratory, Hematological, Hepatic and Renal complications in a central civic hospital and teaching institute in India. PARTICIPASNTS All patients > 18 years presenting with fever and thrombocytopenia with platelet count of < 150 × 109/L. RESULTS Number of patients requiring platelet transfusions decreases when total risk score is used for risk stratification and for transfusing platelets as against the platelet count at admission. Patients who died in our study had a platelet count at presentation between 20,000- 1,00,000 though their total risk score was 17 and 18 respectively; hence platelet count alone should not be relied upon for platelet transfusion. Irrespective of the number of platelets transfused the prognosis is poor as the total risk score increases. CONCLUSIONS The platelet count is not the only indicator of transfusion. When we use total risk score instead of platelet count for classifying patients who need transfusions, number of patients who fall in severe risk category needing immediate transfusion reduces and haphazard use of platelets can be avoided. Patient outcome (death/survival), occurrence of complications and hematological manifestations (petechiae/purpura etc) are not dependent on platelet count at presentation. There is a significant association between risk category and patient outcome.