BACKGROUND Febrile thrombocytopenia is commonly caused by infections like malaria, dengue, typhoid, septicaemia, etc. The present study is intended to know the underlying aetiology, various presentations and complications of febrile thrombocytopenia in our region. MATERIALS AND METHODS This prospective observational study included patients with acute febrile illness and thrombocytopenia presented to our institute in two-year period. RESULTS Febrile thrombocytopenia affected all age group ranging from 12 to 80 years of age, but was common in 12-40 years age group (71.95%) with male-to-female ratio 1.22:1. More than two thirds of cases were recorded in second half of year with half of all cases presented in rainy season. 29.73% patients had platelets <50,000/mm 3 while half of the patients had platelet count between 50,001-1,00,000/mm3. Common causes of febrile thrombocytopenia were malaria (39.6%), dengue (29.8%), mixed infections due to dengue, malaria and enteric fever (19%), enteric fever (16%). Laboratory profile showed deranged liver function tests in 30% patients, renal function in 14% patients and altered coagulation profile 9% patients. About 95% patients had good recovery, 8 patients succumbed during treatment, 62.5% were due to dengue with multiorgan dysfunction and 25% were due to complicated malaria. CONCLUSION Febrile thrombocytopenia in our region is commonly caused by infections particularly malaria and dengue. Its manifestations are related to underlying condition and bleeding manifestation as a primary presentation is uncommon. Mortality in febrile thrombocytopenia is not directly associated with degree of thrombocytopenia, but with concomitant involvement of other organs leading to multiorgan dysfunction.