Abstract        Introduction: Fever is a common manifestation of an illness. Thrombocytopenia is a frequent finding in febrile illness. Thrombocytopenia with fever narrows the differential diagnosis of clinical entity and helps in reaching the diagnosis of febrile illness. Hence this study is undertaken to identify the causes of febrile thrombocytopenia and to assess the severity of thrombocytopenia in various etiologies of febrile thrombocytopenia. Material and Methods: The study was done in Department of Medicine in Indira Gandhi Government Medical College, Nagpur during January 2011 to October 2012.The study is a hospital based observational study. Total 122 cases were enrolled for the study. Results: Malaria was the leading cause of febrile thrombocytopenia (44.26%) followed closely by viral fever (22.13%). The other causes were dengue fever (18.85%), septicaemia (9.83%), leptospirosis (3.27%) and scrub typhus (1.63%). The patients were in the age group 13-58 years with 70 males and 52 females. Maximum patients (61.46%) were found to have thrombocytopenia in the range of 50,000-1, 50,000/cumm.13 cases (10.65%) had thrombocytopenia in the range <20,000/cumm while 34 cases had thrombocytopenia in the range 20,000-50,000/cumm. Bleeding manifestations were present in 33 cases (27.06%) with petechiae as the commonest bleeding manifestation (13.93%).Severe thrombocytopenia was seen commonly in leptospirosis (50%), dengue fever (21.73%) and falcifarum malaria(10%) cases. Mortality was noted in 12 cases (9.83%) and multiorgan dysfunction was present in all those 12 cases. Conclusions: Malaria is the commonest cause of febrile thrombocytopenia. Asymptomatic thrombocytopenia was present in 89(72.94%) cases while symptomatic thrombocytopenia was present in 33(27.06%) cases. Petechiae was the commonest bleeding manifestation(13.93%)among symptomatic thrombocytopenia. Complicated malaria, septicemia, leptospirosis and dengue fever were the diagnosis of patients who died. Severity of thrombocytopenia was not associated with increased mortality. All 12 patients of febrile thrombocytopenia died due to multiorgan failure.