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Background   Plasmodium vivax  is the most geographically widespread species among human malaria parasites. Immunopathological studies have shown that platelets are an important component of the host innate immune response against malaria infections. The objectives of this study were to quantify thrombocytopaenia in  P. vivax  malaria patients and to determine the associated risks of severe thrombocytopaenia in patients with vivax malaria compared to patients with  P. falciparum  malaria.    Main body  A systematic review and meta-analysis of the available literature on thrombocytopaenia in  P. vivax  malaria patients was undertaken. Relevant studies in health-related electronic databases were identified and reviewed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Fifty-eight observational studies ( n  = 29 664) were included in the current review. Severe thrombocytopaenia (< 50 000/mm 3 ) to very severe thrombocytopaenia (< 20 000/mm 3 ) was observed in 10.1% of patients with  P. vivax  infection. A meta-analysis of 11 observational studies showed an equal risk of developing severe/very severe thrombocytopaenia between the patients with  P. vivax  malaria and those with  P. falciparum  malaria ( OR : 1.98, 95%  CI : 0.92–4.25). This indicates that thrombocytopaenia is as equally a common manifestation in  P. vivax  and  P. falciparum  malaria patients. One study showed a higher risk of developing very severe thrombocytopaenia in children with severe  P. vivax  malaria than with severe  P. falciparum  malaria ( OR : 2.80, 95%  CI : 1.48–5.29). However, a pooled analysis of two studies showed an equal risk among adult severe cases ( OR : 1.19, 95%  CI : 0.51–2.77). This indicates that the risk of developing thrombocytopaenia in  P. vivax  malaria can vary with immune status in both children and adults. One study reported higher levels of urea and serum bilirubin in patients with  P. vivax  malaria and severe thrombocytopaenia compared with patients mild thrombocytopaenia or no thrombocytopaenia, ( P  < 0.001 in all comparisons). A pooled analysis of two other studies showed a similar proportion of bleeding episodes with thrombocytopaenia in severe  P. vivax  patients and severe  P. falciparum  patients ( P  = 0.09). This implied that both  P. vivax  and  P. falciparum  infections could present with bleeding episodes, if there had been a change in platelet counts in the infected patients. A pooled analysis of another two studies showed an equal risk of mortality with severe thrombocytopaenia in both  P. vivax  and  P. falciparum  malaria patients ( OR : 1.16, 95%  CI : 0.30–4.60). However, due to the low number of studies with small sample sizes within the subset of studies that provided clinically relevant information, our confidence in the estimates is limited.    Conclusion  The current review has provided some evidence of the clinical relevance of severe thrombocytopaenia in  P. vivax  malaria. To substantiate these findings, there is a need for well designed, large-scale, prospective studies among patients infected with  P. vivax.  These should include patients from different countries and epidemiological settings with various age and gender groups represented.    Electronic supplementary material  The online version of this article (10.1186/s40249-018-0392-9) contains supplementary material, which is available to authorized users.

Severe thrombocytopaenia in patients with vivax malaria compared to falciparum malaria: a systematic review and meta-analysis