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Assessment of Bleeding in Acute Febrile Illness with Thrombocytopenia Using Thromboelastography and Conventional Coagulation Parameters in the Emergency Department (ABATE): A Prospective Cohort Study
Rachana Bhat
Rachana Bhat
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Nitin Gupta
Nitin Gupta
Department of Infectious Diseases, Center for Tropical Febrile Illness (TroFI), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Prithvishree Ravindra
Prithvishree Ravindra
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Praveen Kumar Tirlangi
praveen.tirlangi@manipal.edu
Praveen Kumar Tirlangi
Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Ganesh V. Mohan
Ganesh V. Mohan
Department of Immunohematology & Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Khalid Mohammad
Khalid Mohammad
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Ankit Kumar Sahu
Ankit Kumar Sahu
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Ashwitha Bhat
Ashwitha Bhat
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Jayaraj Mymbilly Balakrishnan
Jayaraj Mymbilly Balakrishnan
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Kavitha Saravu
Kavitha Saravu
Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India;
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Acute febrile illnesses (AFIs) with thrombocytopenia, such as dengue, leptospirosis, and scrub typhus, are often associated with bleeding and present challenges in transfusion therapy during outbreaks. Conventional bleeding predictors, which involve platelet counts, do not assess clot strength or fibrinolysis defects and may lead to inappropriate or delayed transfusions. To predict bleeding, we aimed to create a scoring system using point-of-care thromboelastography (TEG) and other conventional coagulation parameters. In this prospective cohort study, patients with AFI and platelet counts <100,000/cu mm who presented to the emergency department were recruited, and samples were collected for conventional coagulation tests and TEG analysis at admission. Patients were monitored for 48 hours for bleeding events, blood product transfusions, and mortality within 7 days. Receiver operating characteristic curves were plotted for significant predictors identified in univariate analysis, and a scoring system was generated using stepwise logistic regression. Sixty-six patients were recruited, including 38 with dengue and 11 with leptospirosis. Nineteen patients experienced a bleeding event within 48 hours. Dyspnea and elevated aspartate transaminase levels were more prevalent among those who bled. Thromboelastography parameters (reaction time/maximum amplitude [R/MA]), prothrombin time, international normalized ratio (INR), and baseline platelet count were significant predictors of bleeding. A scoring system using R/MA, INR, and platelet count achieved an overall predictive accuracy of 83.3% for 48-hour bleeding, with a score ≥3 demonstrating a sensitivity of 68% and specificity of 77%. Thromboelastography in patients with dengue showed more significant coagulation abnormalities than in those with leptospirosis. Validation in larger, more homogeneous populations is necessary.
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Author Notes
Financial support: This work was supported by the
Disclosure: The study was initiated after obtaining clearance from the institutional ethical committee (ref no: IEC 182/2023).
Current contact information: Rachana Bhat, Prithvishree Ravindra, Khalid Mohammad, Ashwitha Bhat, and Jayaraj Mymbilly Balakrishnan, Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, E-mails: rachana.bhat@manipal.edu or rachana2806@gmail.com, prithvishree.r@manipal.edu, khalid.mohammad@manipal.edu, ashwithabhat97@gmail.com, and jayaraj.mb@manipal.edu. Nitin Gupta, Center for Tropical Febrile Illness, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, E-mail: nitin.gupta@manipal.edu. Praveen Kumar Tirlangi and Kavitha Saravu, Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, E-mails: praveen.tirlangi@manipal.edu and kavitha.saravu@manipal.edu. Ganesh V. Mohan, Department of Immunohematology & Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, E-mail: ganesh.mohan@manipal.edu. Ankit Kumar Sahu, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India, E-mail: ankitkumarsahu13@gmail.com.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 895 | 895 | 652 |
| Full Text Views | 23 | 23 | 6 |
| PDF Downloads | 20 | 20 | 2 |