A 12 years old boy with history of recent travel to India is brought to the clinic with history of a low-grade fever with chills and rigors since 2 days. He also has a purpuric rash all over his body. On examination there is clinically distinct pallor and purpuric spots all over his body. The purpura are not palpable. On hematological testing his platelet count is 20,000 per cumm.
Thrombocytopenia is defined as
- Platelet count of less than 140,000 per cumm.
- Platelet count of less than 50,000 per cumm.
- Platelet count of less than 20,000 per cumm.
- Platelet count of less than 100,000 per cumm.
Answer: The answer is (a). Thrombocytopenia is defined as a platelet count of less than 140,000 per cumm. The risk of spontaneous life threatening bleeds increases with a platelet count of less than 20,000 per cumm. This risk is substantially high when the platelet count falls below 10,000 per cumm. Elective surgery is not done unless platelet count is over 50,000.
The single most important reason for admitting this boy in the hospital is
- Risk of life threatening cerebral bleed
- Risk of hypotension and shock
- Risk of spreading the causative agent to his contacts
- Risk of postponing or delaying treatment.
Answer: The answer is (a). When the platelet count falls below 20,000 per cumm the risk of spontaneous life threatening bleeds increases. Therefore hospitalization and platelet transfusion is indicated in this case. There is a risk of hypotension and shock if excessive bleeding from the gastrointestinal tract occurs.
The cause for this boy’s fever, rash and thrombocytopenia is
- Dengue hemorrhagic fever
- Malaria
- Rocky Mountain Spotted Fever
- Disseminated tuberculosis
Answer: The answer is (a). Dengue hemorrhagic fever is caused due to an arbovirus, which is spread by the bite of Aedes mosquitoes. It is a typical tropical disease very common in India. Therefore the history of recent travel to India is significant in this case. Also called breakbone fever due to the severe myalgias it causes. Associated with severe headaches too. 4 serotypes exist. When infected with any one serotype only, it is not too dangerous but if 2 serotypes co-infect a patient, it can be life threatening. Avoid Aspirin. Supportive treatment is key.