European Journal of Cardiovascular Medicine

Thrombocytopenia is defined as decrease in platelet count below the lower limit for the age and sex of the person.For adults, platelet count less than 1, 50,000/μL is considered as thrombocytopenia.1Mild thrombocytopenia is defined as platelet count between 1, 00,000/μL to 1, 50,000/μL, moderate between 50,000/μL to 1, 00,000/μL and severe as less than 50,000/μL.1Usually patients with platelet count more than 50,000/μL are asymptomatic.2

It can be caused by many mechanisms: reduced production in bone marrow, destruction of platelets in peripheral blood or sequestration in enlarged spleen.3   Pseudo thrombocytopenia can also be caused by EDTA sampling4 or in case of presence of giant platelets which are not counted by CBC machine which report it as low platelet count.5

Thrombocytopenia leads to manifestation of bleeding in the form of petechiae, purpura, ecchymoses or epistaxis.6It can be an incidental finding or it can be a cause of morbidity or sometimes even life-threatening bleeding manifestations.7Hence, determining the exact cause of thrombocytopenia is necessary and can be lifesaving. The exact etiology can be determined by patient’s clinical history, examination findings, laboratory investigations and bone marrow examination.8

AIMS AND OBJECTIVES

The aims and objectives of the present study was to evaluate the etiology of patients >18 years of age presenting with thrombocytopenia.

120 patients with thrombocytopenia presenting between July 2022 to December 2022 was selected in this prospective hospital based study.

Inclusion criteria :> 18 years, platelet count <1, 50,000/μL.

Exclusion criteria :< 18 years, patients who did not give consent.

Investigations: complete blood count, manual platelet count by peripheral blood smear, malarial parasite antigen, Widal test, dengue serology, Coombs test, abdominal ultrasound.

The etiology of all adult patients presenting with thrombocytopenia were diagnosed by clinical and laboratory work up and following results were obtained (Table 1):

Table 1: Frequency and percentage of all etiologies of thrombocytopenia in adults

In the present study, the most common cause of thrombocytopenia in adults was found to be malaria (27.5%) followed by dengue (25%) and megaloblastic anemia (20%). The other causes were found to be leukemia (14.2%), septicemia(3.3%), chronic liver disease(2.5%), enteric fever (2.5%), aplastic anemia (1.7%), hypersplenism (1.7%), myelofibrosis (0.8%) and drug induced (0.8%).

The different species of plasmodium causing malaria with thrombocytopenia occurred in the following frequency (Table 2)

Table 2: Frequency of different species of Plasmodium causing thrombocytopenia

The most common species of plasmodium causingthrombocytopenia was found to be Plasmodium vivax.

In the study conducted by Vimal M et al in 2016,⁹the various causes weredengue (21.67%), malaria (6.7%), enteric fever (5.9%), septicemia (5%), chronic liver disease (16.7%), chronic kidney disease (3.4%), diabetes (7.7%), malignancy (1.67%), coronary artery disease (3.4%), pregnancy (5%), hematological disorders (18.4%) and miscellaneous (5%).

In the study conducted by Poornima Mitra et alin 2019,¹⁰the most common cause was dengue (23.70%), malaria (14.81%), enteric fever (14.07%), septicemia (12.6%), liver diseases (8.14%), kidney diseases (4.44%), immune thrombocytopenic purpura (6.66%), leukemias (3.70%), pregnancy (6.66%) and others (5.18%).

In the study conducted by Sruthi K Bhalara et alin 2014,²dengue was again most common cause (28.6%), followed by malaria in 22.8%, chronic liver disease in 15.2%, hypersplenism in 12.3%, septicemia in 6.3%, gestational thrombocytopenia and disseminated intravascular coagulation in 5.5%, immune thrombocytopenic purpura (ITP) in 3.1%, megaloblastic anemia in 1.9%, human immunodeficiency virus in 1.4%, drug-induced thrombocytopenia in 1.2%, leukemia in 0.7%, and aplastic anemia in 0.48%.

Akruti Patel et al in 2020¹¹found Plasmodium vivax (52%) to be the most common cause, followed by megaloblastic anemia (27%) and other causes.

Thrombocytopenia can be caused by a variety of conditions ranging from infective to nutritional deficiency to leukemia and other causes. Correct diagnosis of etiology of thrombocytopenia is utmost essential to prevent life-threatening complications of bleeding. Our study found the most common cause of thrombocytopenia was malaria and dengue both of which are caused due to mosquitoes. The third cause was megaloblastic anemia, which is most commonly caused by due to nutritional deficiency of vitamin B12 and folate.

Hence, we can conclude that thrombocytopenia is potentially preventable in our scenario. Appropriate protection from mosquitoes by using mosquito net, preventing stagnant water in and around our homes are simple steps which can protect us from mosquito borne diseases. Megaloblastic anemia can be prevented by taking proper diet rich in vitamin B12 and folate like eggs, milk, meat, green leafy vegetables, etc. Prompt diagnosis of other causes of thrombocytopenia like leukemia, chronic liver disease, enteric fever etc. can help prevent serious complications and will help in better outcome of the patient.

Acknowledgement

Dr. Amrta Tiwari conceived the idea, Dr. Mohammad Frayez did the review of literature and collected data, Dr. Naziya Shaikh did proofreading of the paper.

Funding: None

Conflict of interest: None

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