Analysis of Prognostic Indicators in Fever Associated with Thrombocytopenia Among Children Up to 12 Years

Kumaran V et al | DOI: 10.65188/nurexus.1051

Page 29

Journal of MedVerse Research & Practice

ISSN: 3107-4278

Analysis of Prognostic Indicators in Fever Associated with

Thrombocytopenia Among Children Up to 12 Years

Dr. Vidhya Kumaran

, Dr. Parvathy Gopinath

Assistant Professor, Professor

Department of Pediatrics,

Pushpagiri Medical College and Hospital Research Institute, Kerala.

Email ID: vidhyakumaran@gmail.com,

Submission Date: 25.10.2025

Accepted Date: 25.11.2025

Published Date: 30.11.2025

DOI: 10.65188/nurexus.1051

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Fever associated with thrombocytopenia is a common clinical presentation in paediatric practice, particularly in

regions with a high prevalence of infectious diseases. This study aimed to analyse prognostic indicators and clinical

outcomes in children up to 12 years presenting with fever and thrombocytopenia. A cross-sectional observational

study was conducted on 150 children admitted with fever (>99.9°F) and platelet counts below 150,000/µL at

Pushpagiri Medical College and Hospital Research Institute, Kerala. Detailed clinical evaluation, laboratory

investigations, and outcome assessment were performed. Dengue fever emerged as the most prevalent etiology

(41.3%), followed by non-dengue viral fever (25.3%), enteric fever (14%), sepsis (11.4%), and malaria (8%). Most

children exhibited mild to moderate thrombocytopenia (74%). The majority (74.7%) improved with supportive

management, while 18.7% required ICU admission. Complications such as bleeding or shock occurred in 5.3% of

cases, and the mortality rate was 1.3%. Younger age groups and severe thrombocytopenia were more frequently

associated with adverse outcomes. The findings underscore the need for early identification of high-risk children,

careful monitoring, and timely intervention to prevent complications. Strengthening diagnostic practices and

clinician awareness can significantly improve outcomes in paediatric febrile thrombocytopenia.

Keywords: Fever; Thrombocytopenia; Children; Prognostic indicators; Dengue fever; Paediatric infections;

Platelet count; Clinical outcomes; Complications; ICU admission.

Introduction

Fever with thrombocytopenia is one of the most frequently encountered clinical presentations in pediatric

emergency and inpatient settings, particularly in countries with a high burden of infectious diseases. In

children, the coexistence of fever and reduced platelet count often signals an underlying systemic illness,

most commonly infectious in origin, and warrants careful evaluation to determine severity and potential

complications [1]. The pediatric population is especially vulnerable due to their immature immune

response and higher susceptibility to rapid clinical deterioration during acute infections [2].

Thrombocytopenia in febrile children may arise from a wide range of etiologies, including viral infections

(such as dengue, chikungunya, influenza, or viral hemorrhagic fevers), bacterial illnesses (such as

septicemia, meningitis, or enteric fever), protozoal infections like malaria, and bone marrow–suppressive

conditions [3,4]. Among these, dengue remains one of the most prevalent causes of acute

thrombocytopenia in pediatric age groups in many tropical regions, causing significant morbidity and

occasional mortality due to plasma leakage, bleeding, and organ dysfunction [5]. In malaria-endemic

Kumaran V et al | DOI: 10.65188/nurexus.1051

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areas, Plasmodium falciparum and Plasmodium vivax infection also contribute substantially to

thrombocytopenia through immune-mediated destruction and bone marrow suppression [6].

Platelets play a vital role in hemostasis, inflammation, and immune regulation; therefore, a decline in

platelet count can have serious implications in an already febrile child. Studies have shown that severe

thrombocytopenia is often associated with increased risk of bleeding, shock, prolonged hospitalization,

and need for intensive care support [7,8]. Early identification of prognostic markers—such as persistent

high-grade fever, rapid fall in platelet count, elevated liver enzymes, coagulopathy, positive serological

markers, hepatosplenomegaly, and warning signs of dengue—can help clinicians anticipate complications

and initiate timely management [9].

The clinical spectrum of febrile thrombocytopenia in children is highly variable. While some children

experience mild thrombocytopenia with complete recovery, others may present with complications such

as mucosal bleeding, petechiae, altered sensorium, hepatic dysfunction, or multi-organ involvement,

depending on the underlying disease and immune response [10]. Moreover, the lack of disease-specific

symptoms in early stages often leads to diagnostic uncertainty, making it essential to rely on laboratory

parameters and clinical predictors to guide treatment decisions [11]. In resource-limited settings, where

advanced diagnostic facilities may not be readily available, understanding simple and reliable predictors

of outcomes becomes even more crucial. Identifying which children are at higher risk for severe disease

not only helps clinicians prioritize monitoring and interventions but also improves resource utilization and

reduces preventable morbidity and mortality [12]. Therefore, evaluating prognostic indicators in children

with fever and thrombocytopenia remains an important area of research, contributing to better disease

stratification and improved clinical outcomes.

Materials and Methods

This observational cross-sectional study was conducted over a period of 18 months and included children

aged above 1 month and below 12 years who presented with fever exceeding 99.9°F and

thrombocytopenia, defined as a platelet count below 150,000/µL. Eligible participants were those

admitted with febrile thrombocytopenia to Pushpagiri Medical College and Hospital Research Institute,

Kerala. Children with thrombocytopenia without fever, known cases of immune thrombocytopenic

purpura, previously diagnosed hematological disorders or malignancies, those receiving chemotherapy or

immunosuppressive therapy, children with platelet function disorders, those taking antiplatelet or

thrombocytopenia-inducing medications, and patients with cirrhosis or chronic liver disease were

excluded from the study. The research was carried out at Pushpagiri Medical College and Hospital

Research Institute, Kerala, using a convenience sampling technique, and the final sample size was 150

children. Ethical clearance has been obtained. After explaining the purpose and procedure of the study,

written informed consent was obtained from the parents or guardians of all participants. Blood samples

were collected at the time of admission for laboratory evaluation. All collected data were entered

systematically and analyzed using SPSS software with the assistance of a trained data entry operator and

statistician, aiming to identify predictors influencing the outcomes of fever with thrombocytopenia in

children up to 12 years of age.

The study obtained ethical approval from the Institutional Ethics Committee of Pushpagiri Medical

College and Hospital Research Institute, Kerala (Ref No: PMCHRI/EC/2024/64308). A detailed

Participant Information Sheet was provided to all participants, and written informed consent was obtained

prior to their participation in the study.

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Results

Table 1: Age Distribution of Children with Fever and Thrombocytopenia (n = 150)

Age Group

Number of Cases (n)

Percentage (%)

1 month – <1 year

14.7%

1 – 5 years

32.0%

6 – 9 years

29.3%

10 – 12 years

24.0%

Total

150

100%

The study included 150 children with fever and thrombocytopenia, ranging from 1 month to 12 years of

age. The largest proportion of cases occurred in the 1–5-year age group (32%), followed by children aged

6–9 years (29.3%). Infants below 1 year constituted 14.7%, while children aged 10–12 years made up

24% of the study population.

Table 2: Gender Distribution of Study Participants

Gender

Number (n)

Percentage (%)

Male

57.3%

Female

42.7%

Total

150

100%

In this study of 150 children with fever and thrombocytopenia, males accounted for 57.3% (n=86) of the

cases, while females constituted 42.7% (n=64).

Figure 1: Etiological Profile of Fever with Thrombocytopenia

In this study, dengue fever was the most common cause, accounting for 41.3% (n=62) of the cases of

fever with thrombocytopenia. This was followed by viral fever of non-dengue origin at 25.3% (n=38) and

enteric fever at 14% (n=21). Malaria contributed to 8% (n=12) of cases, while sepsis or bacterial

infections accounted for 11.4% (n=17).

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Table 3: Severity of Thrombocytopenia Among Study Participants

Platelet Count Category

Number (n)

Percentage (%)

Mild (100,000–150,000/µL)

39.3%

Moderate (50,000–99,999/µL)

34.7%

Severe (<50,000/µL)

26.0%

Total

150

100%

In this study, most children presented with mild thrombocytopenia, accounting for 39.3% (n=59) of the

cases. Moderate thrombocytopenia was seen in 34.7% (n=52) of the participants, while severe

thrombocytopenia was observed in 26% (n=39).

Table 4: Clinical Outcomes of Children with Fever and Thrombocytopenia

Outcome

Number (n)

Percentage (%)

Improved with Supportive Treatment

112

74.7%

Required ICU Care

18.7%

Developed Complications (Bleeding / Shock)

5.3%

Mortality

1.3%

In this study, the majority of children, 74.7% (n=112) showed improvement with standard supportive

treatment, indicating a generally favorable prognosis. However, 18.7% (n=28) required ICU care due to

more severe presentations. A small proportion, 5.3% (n=8), developed complications such as bleeding or

shock. Mortality was low, recorded in 1.3% (n=2) of the total cases.

Discussion

In this study of 150 children presenting with fever and thrombocytopenia, distinct epidemiological and

clinical patterns were observed. The age distribution revealed that the most affected group was 1–5

years (32%), followed by 6–9 years (29.3%), indicating a higher susceptibility among younger

children. Similar age-related patterns have been reported by Saravu et al. and Kumar et al., who

demonstrated that febrile thrombocytopenia is more common in preschool and early school-aged

children [14,15]. A male predominance was noted in the present study (57.3% males vs. 42.7%

females), which is consistent with findings by Patel et al. and Shrivastava et al., both of whom

reported a comparable male preponderance in pediatric thrombocytopenia [23,17]. This gender

difference may be related to increased outdoor exposure among male children, predisposing them to

vector-borne infections.

Regarding etiology, dengue fever was identified as the most common cause (41.3%), followed by non-

dengue viral fevers (25.3%), enteric fever (14%), sepsis (11.4%), and malaria (8%). The

predominance of dengue aligns with observations by Gupta et al., Narayanappa et al., and Lokireddy

et al., who consistently reported dengue as the leading cause of febrile thrombocytopenia in children

[9,2,3]. The endemic nature of dengue in South India and its seasonal outbreaks further support these

findings, as highlighted by Chandy et al. and Mathew and Kuruvilla [12,21].

Most children in the present study had mild to moderate thrombocytopenia (74%), while 26% had

severe thrombocytopenia (<50,000/µL). Comparable platelet distribution patterns were reported by

Sharma and Kumar and Patel et al., who noted severe thrombocytopenia in approximately 20–30% of

pediatric cases [22,23]. Although platelet count alone is not a definitive predictor of disease severity,

lower counts are often associated with dengue and bacterial sepsis, as emphasized by Ranjit and

Kissoon and Faust et al. [20,18].

In terms of outcomes, 74.7% of children improved with supportive treatment alone, which is in

Kumaran V et al | DOI: 10.65188/nurexus.1051

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agreement with studies by Mittal et al. and Aggarwal et al., both of whom reported favorable recovery

in the majority of children with febrile thrombocytopenia when managed promptly [6,5]. However,

18.7% of patients required ICU admission, particularly those presenting with persistent shock, severe

bleeding, or organ dysfunction. Similar ICU admission rates have been documented by Kumar and Rai

and Debnath and Sinha [26,24]. Complications such as bleeding or shock occurred in 5.3% of cases,

comparable to the complication rates of 4–7% reported by Wani and Hussain [25].

The mortality rate in the present study was 1.3%, which aligns with findings by Ahmed et al. and

Verma et al., who reported mortality rates ranging from 1% to 3% in hospital-based pediatric cohorts

with febrile thrombocytopenia [27,28]. Overall, the findings reaffirm that fever with

thrombocytopenia in children is a common clinical presentation, most frequently caused by dengue

and viral infections, and is generally associated with favorable outcomes. Nevertheless, children

presenting with severe thrombocytopenia, sepsis, or clinical instability require early identification,

intensive monitoring, and timely intervention to minimize adverse outcomes, as emphasized by Rajesh

et al. [13].

Conclusion

This study highlights that fever associated with thrombocytopenia is a common clinical presentation in

children up to 12 years of age, with dengue fever emerging as the leading cause. Most children had

mild to moderate thrombocytopenia and responded well to supportive management, reflecting the

generally favorable prognosis of these conditions. However, a notable proportion required ICU care,

particularly those with severe thrombocytopenia or underlying bacterial infections. A small but

significant number developed complications such as bleeding or shock, and mortality, though low,

was present. These findings emphasize the importance of early evaluation, close monitoring of platelet

trends, and timely intervention to prevent adverse outcomes. Strengthening awareness and improving

early diagnostic practices can further enhance clinical outcomes in pediatric febrile thrombocytopenia.

Conflict of interest: Nil

Source Of Fund: Nil

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