THROMBOCYTOSIS AS A PREDICTOR AND DIAGNOSTIC TOOL FOR SERIOUS BACTERIAL INFECTION IN FEBRILE INFANTS; SRINAGAR, INDIA.

  • Government Medical College, Srinagar, India.
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Introduction:To estimate the incidence of Reactive Thrombocytosis among febrile young infants and to assess the utility of platelet count as a potential predictor and diagnostic tool of serious bacterial infection (SBI). Methods and Materials:This study was conducted as a prospective non-randomized study between March 2016 to Feb 2018 at the tertiary care pediatric unit, Srinagar, India. Inclusion criteria were all infants 30 to 89 days of age, admitted with rectal temperature>38?C/100.4?F without an apparent focus of infection on history and clinical examination. Exclusion criteria were infants having fever more than 72 hours and who had received antibiotics or vaccination within 48 hours of presentation. Also, the results of the sepsis evaluation on admission were recorded. SBI included all cases of occult bacteremia, urinary tract infection, bacterial meningitis, pneumonia, bacterial gastroenteritis and infections of the soft tissues and bones. Results:Of the 298 infants studied, 78 (26.2%) had SBI. Platelet count was significantly higher in infants with SBI compared to those without {Platelet count ≥ 4 lakhs /mm3 in SBI (84.6%) vs. Non-SBI (42.4%).Mean platelet count 5.1 ? 1.1 in SBI vs. 3.9 ? 1.6 in Non-SBI which was statistically significant (P<0.05). Thrombocytosis had a moderate ability in predicting SBI [Area under curve area under the curve: 0.760]. The combination of platelet count ≥450,000/mm3, WBC ≥15,000/mm3, C-reactive protein ≥2 mg/dl and pyuria ≥5 White blood cells (WBC) per High power field (HPF) resulted in misclassification of only 2 infants with SBI (5.1% of SBIs). Conclusions:Reactive thrombocytosis was a frequent finding in young infants with SBI. Thrombocytosis ≥450,000 cells/mm3, in combination with leukocytosis, elevated C-reactive protein (CRP) and pyuria, may help in early recognition of febrile young infants at risk for SBI.

  1. Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatrics 1990;85: 1040-1043.
  2. Hsiao AL, Baker MD. Fever in the new millennium: a review of recent studies of markers of serious bacterial infection in febrile children. CurrOpinPediatr 2005; 17: 56-61.
  3. Mantadakis E, Tsalkidis A, Chatzimichael. A: Thrombocytosis in childhood. Indian Pediatr 2008; 45: 669-677.
  4. Sutor AH. Thrombocytosis in childhood. SeminThromb Hemost1995;21: 330-9.
  5. Kaushansky K. Thrombopoietin: the primary regulator of platelet Production. Blood 1995; 86:419-31.
  6. Ishiguro A, Suzuki Y, Mito M, Shimbo T, Matsubara K, Kato T, et al. Elevation of serum thrombopoietin precedes thrombocytosis in acute infections. Br J Haematol 2002; 116: 612-18.
  7. Fujiwara T, Harigae H, Kameoka J, Yokoyama H, Takahashi S, Tomiya Y, et al. A case of familial thrombocytosis: possible role of altered thrombopoietin production. Am J Hematol 2004; 76: 395-7.
  8. Kikuchi M, Tayama T, Hayakawa H, Takahashi I, Hoshino H, Ohsaka A. Familial thrombocytosis. Br J Haematol 1995; 89:900-902.
  9. Williams EC, Shahidi NT. Benign familial thrombocytosis. Am J Hematol 1991; 37: 124-5.
  10. Fernandez-Robles E, Vermylen C, Martiat P, Ninane J, Cornu G. Familial essential thrombocythemia.PediatrHematolOncol 1990; 7: 373-6.
  11. Incidence of essential thrombocythemia in children. Br J Haematol 2000; 110: 751.
  12. Yang RC, Qian LS. Essential thrombocythaemia in children: a report of nine cases. Br J Haemato12000; 110: 1009-10.
  13. Papageorgiou T. Theodoridou A. Kourti M, Nikolaidou S, Athanassiadou F, KaloutsiV.Childhood essential thrombocytosis. PediatrBloodCancer 2006; 47: 970-1.
  14. Dror Y, Blanchette V S. Essential thrombocythaemia in children. Br J Haematol 1999; 107: 691- 698.
  15. Dror Y, Zipursky A, Blanchette VS. Essential thrombocythemia in children. J PediatrHematolOncol 1999; 21: 356- 63.
  16. Yohannan MD, Higgy KE, al-Mashhadani SA, Santhosh Kumar CR. Thrombocytosis Etiologic analysis of 663 patients. ClinPediatr 1994; 33: 340-43.
  17. Denton A, Davis P. Extreme thrombocytosis in admissions to paediatric intensive care: no requirement for treatment. Arch Dis Child, 2007; 92:515-16.
  18. Dame C, Sutor AH. Primary and secondary thrombocytosis in Childhood. Br J Haematol 2005; 129: 165-177.
  19. Heng J T, Tan AM. Thrombocytosis in childhood. Singapore Med J 1998;39:485-87.
  20. Vora AJ, Lilleyman JS. Secondary thrombocytosis. Arch Dis Child 1993; 68: 88-90.
  21. Garoufi A, Voutsioti K, Tsapra H, Karpathios T Zeis PM. Reactive thrombocytosis in children with upper urinary tract infections. ActaPaediat 2001; 90: 448-9.
  22. Matsubara K, Fukaya T, Nigami H, Harigaya H, Hirata T, Nozaki H, et al. Age-dependent changes in the incidence and etiology of childhood thrombocytosis. ActaHaematol 2004; 111:132-7.
  23. Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. Br J Haematol 2005;129: 165-77.
  24. O?Shea J, Sherlock M, Philip R. Thrombocytosis in childhood. ActaHaematol 2005; 113: 212.
  25. Vlacha V, Feketea G. Thrombocytosis in paediatric patients is associated with severe lower respiratory tract inflammation. Arch Med Res 2006; 37: 755-9.
  26. Dodig S, Raos M, Kovac K, Nogalo B, Benko B, Glojnaric I, et al. Thrombopoietin and interleukin-6in children with pneumonia-associated thrombocytosis.Arch Med Res 2005; 36: 124-8.
  27. Thomas GA, O?Brien RT. Thrombocytosis in children with Hemophilusinfluenzaemeningitis.ClinPediatr (Phila) 1986; 25: 610-11.
  28. Garoufi A, Voutsioti K, Tsapra H, Karpathios T, Zeis PM. Reactive thrombocytosis in children with upper urinary tract infections. ActaPaediatr 2001;90: 448-9.
  29. Dharnidharka VR, Kandoth PW. Prevalence of bacteriuria in febrile infants. Indian Pediatr 1993;30: 987-990.
  30. Fouzas S, Mantagou L, Skylogianni E, Varvarigou A. Reactive Thrombocytosis in Febrile Young Infants with Serious Bacterial Infection Indian Pediatr. 2010; 47(11):937-43.
  31. Dodig S, Raos M, Kovac K, Nogalo B, Benko B, Glojnaric I, et al. Thrombopoietin and interleukin-6in children with pneumonia-associated thrombocytosis.Arch Med Res 2005; 36: 124-8.
  32. Thomas GA, O?Brien RT. Thrombocytosis in children with Hemophilusinfluenzaemeningitis.ClinPediatr (Phila) 1986; 25: 610-11.
  33. Garoufi A, Voutsioti K, Tsapra H, Karpathios T, Zeis PM. Reactive thrombocytosis in children with upper urinary tract infections. ActaPaediatr 2001;90: 448-9.
  34. Dharnidharka VR, Kandoth PW. Prevalence of bacteriuria in febrile infants. Indian Pediatr 1993;30: 987-990.
  35. Fouzas S, Mantagou L, Skylogianni E, Varvarigou A. Reactive Thrombocytosis in Febrile Young Infants with Serious Bacterial Infection Indian Pediatr. 2010; 47(11):937-43.

[Sumaira Chowdhary, Shiekh Junaid Aziz and Navneet Kaur. (2019); THROMBOCYTOSIS AS A PREDICTOR AND DIAGNOSTIC TOOL FOR SERIOUS BACTERIAL INFECTION IN FEBRILE INFANTS; SRINAGAR, INDIA. Int. J. of Adv. Res. 7 (Mar). 196-201] (ISSN 2320-5407). www.journalijar.com

Dr Sumaira Chowdhary
Demonstrator, Postgraduate Department of Physiology, Goverment Medical College Srinagar. Jammu And Kashmir.

DOI:

Article DOI: 10.21474/IJAR01/8621      
DOI URL: https://dx.doi.org/10.21474/IJAR01/8621

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