The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis

Joshua Hanson, Nguyen H oan Phu, Mahtab U ddin Hasan, Prakaykaew Charunwatthana, Katherine Plewes, Richard J. Maude, Panote Prapansilp, Hugh W F Kingston, Saroj K. Mishra, Sanjib Mohanty, Ric N. Price, M. Abul Faiz, Arjen M. Dondorp, Nicholas J White, Tran T inh Hien, Nicholas P J Day

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Abstract

Background: Thrombocytopenia is a common finding in adults with severe falciparum malaria, but its clinical and prognostic utility is incompletely defined.

Methods: Clinical and laboratory data from 647 adults with severe falciparum malaria were analysed retrospectively to determine the relationship between a patient's platelet count on admission to hospital and their subsequent clinical course.

Results: On admission, 614 patients (94.9%) were thrombocytopenic (platelet count <150 × 10(9)/L) and 328 (50.7%) had a platelet count <50 × 10(9)/L. The admission platelet count was inversely correlated with parasite biomass (estimated from plasma PfHRP2 concentrations, rs = -0.28, P = 0.003), the degree of microvascular sequestration (measured with orthogonal polarizing spectral imaging, rs = -0.31, P = 0.001) and disease severity (the number of World Health Organization severity criteria satisfied by the patient, rs = -0.21, P <0.001). Platelet counts were lower on admission in the patients who died (median: 30 (interquartile range 22 to 52) × 10(9)/L versus 50 (34 to 78) × 10(9)/L in survivors; P <0.001), but did not predict outcome independently from other established laboratory and clinical prognostic indices. The 39 patients (6%) with profound thrombocytopenia (platelet count <20 × 10(9)/L) were more likely to die (odds ratio: 5.00, 95% confidence interval: 2.56 to 9.75) than patients with higher platelet counts, but these high-risk patients could be identified more rapidly with simple bedside clinical assessment. The admission platelet count did not reliably identify the 50 patients (7.7%) with major bleeding during the study.

Conclusions: Thrombocytopenia is a marker of disease severity in adults with falciparum malaria, but has limited utility in prognostication, triage and management.

Original languageEnglish
Article number97
Pages (from-to)1-9
Number of pages9
JournalBMC Medicine
Volume13
DOIs
Publication statusPublished - 24 Apr 2015

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    Hanson, J., Phu, N. H. O., Hasan, M. U. D., Charunwatthana, P., Plewes, K., Maude, R. J., Prapansilp, P., Kingston, H. W. F., Mishra, S. K., Mohanty, S., Price, R. N., Faiz, M. A., Dondorp, A. M., White, N. J., Hien, T. T. I., & Day, N. P. J. (2015). The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis. BMC Medicine, 13, 1-9. [97]. https://doi.org/10.1186/s12916-015-0324-5