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Clinical Pediatrics
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Extreme Thrombocytosis Predicts Kawasaki Disease in Infants

Lise E. Nigrovic, MD

Divisions of Emergency Medicine

Peter A. Nigrovic, MD

Divisions of Allergy, Immunology and Rheumatology, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA.

Marvin B. Harper, MD

Divisions of Emergency Medicine Divisions of Infectious Diseases

Vincent W. Chiang, MD

Divisions of Emergency Medicine Department of Medicine, Children’s Hospital Boston

Infants with Kawasaki disease are at high risk of developing life-threatening coronary complications, yet may elude timely diagnosis because they often lack the full complement of classic clinical features. We retrospectively studied 26,540 children 1 year of age or less who were evaluated at a tertiary care pediatric emergency department in whom a platelet count was performed. Among those infants with fever without a source identified, 8.5% with platelet counts of 800,000 cells/mm3 or greater had Kawasaki disease compared to 0.4% with platelet counts of less than 800,000 cells/mm3 (likelihood ratio for Kawasaki disease was 17 [95% confidence interval, 8-34]). Because many infants present atypically, Kawasaki disease should be considered in all children of 1 year or less with prolonged fever, extreme elevation of the platelet count, and no compelling alternative diagnosis.

Clinical Pediatrics, Vol. 45, No. 5, 446-452 (2006)
DOI: 10.1177/0009922806289621
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