A Clinicopathological Study of Thrombocytopenia in Malaria Cases with Its Evaluation in Different Types of Malaria

BACKGROUND Malaria is a global health problem, caused by the protozoa plasmodium and is characterized by haematological abnormalities, with thrombocytopenia being the most common. Microscopic examination of thick and thin blood films is the gold standard in diagnosis of malaria. This study was conducted to assess the severity of thrombocytopenia in malaria patients and to correlate it with the type of malaria. METHODS A retrospective study was conducted in Yenepoya Medical College, Hospital, Mangalore for a period of 1.5 years. Patients of all ages who were hospitalized or attending OPD were included. Patients with dengue fever and drug-induced thrombocytopenia were excluded. Complete blood cell count was done using an automated cell count analyser. Thrombocytopenia was defined as a platelet count < 150,000 / μl. It was graded as severe: platelet count < 50,000/ μl, moderate: 50,000- 100,000/ μl and mild: 100,000-150,000 /μl. RESULTS Our study included 120 malaria positive cases with 102 (85 %) males and 18 (15 %) females. 90.8 % cases presented with thrombocytopenia, predominantly moderate to severe thrombocytopenia (80.7 %). Plasmodium vivax (Pv) was the most common species found in our study. Ninety-nine (82.5 %) cases were positive for Plasmodium vivax (Pv), 8 (6.6 %) cases for Plasmodium falciparum (Pf) and 13 (10.8 %) cases had mixed infection with both Plasmodium vivax and Plasmodium falciparum. Out of 99 cases which had vivax malaria, 88 (88.9 %) cases had thrombocytopenia. All 8 cases detected with falciparum malaria and 13 cases with mixed infection had thrombocytopenia. CONCLUSIONS The above findings can have therapeutic implications in avoiding unnecessary platelet infusion in malaria patients. Presence of thrombocytopenia in a patient with acute febrile illness can heighten suspicion of malaria, and initiate prompt treatment. KEY WORDS Thrombocytopenia, Malaria, Severity