Study of Platelet Count in Malaria Patients and the Correlation Between the Presence and Severity of Platelet Count With Type of Malaria

BACKGROUND: Malaria remains one of the major health problems in the tropics with increased morbidity & mortality.Thrombocytopenia is a common finding in malaria, but its correlation with the type of malaria and prognostic implications in context with severity of low platelet count has not been evaluated in large studies.In view of paucity of data from Indian studies, we attempt to correlate the low platelet count with type of malaria and outcome.AIM: Study of platelet count in malaria patients and correlation between the presence and severity of platelet count with type of malaria.MATERIAL & METHODS: A total of 180 patients diagnosed to have Malaria over a period of two years admitted in Guntur Teaching and General Hospital attached to Guntur Medical College, Guntur were studied.All study subjects were identified positive for Malaria parasite on peripheral smear examination with conventional microscopy.Platelet count was done on a fully automated, quantitative analyzer.Daily platelet count was done for all those admitted with malaria.P.falciparum antigen test (PfHrp antigen test-Parascreen) was performed in subjects with P.vivax Malaria on the peripheral smear with a platelet count less than 20,000cells/cmm for more emphatic exclusion of associated P.falciparum infestation.P.falciparum antigen test was also performed in subjects with high index of clinical suspicion or multi organ involvement.RESULTS: a total of 180 patients were found to have malaria, 114(63.3%)were P.vivax, 62(34.4%)were P.falciparum and 4(2.7%) were mixed.146(81.1%)patients had thrombocytopenia.34(23.3%)developed complicated malaria.Severe thrombocytopenia was noted in 58.8% of complicated malaria with p<0.001.20 patients persisted to have thrombocytopenia on 6th day even after adequate therapy.14(70%) patients out of 20 recovered and 6(30%) died in which 2 was P.falciparum and 4 were mixed infection.CONCLUSION: Thrombocytopenia is a common association of malaria with incidence of 81.1%.Severe thrombocytopenia is commonly seen in P.falciparum.Platelet count <20,000 was seen in P. falciparum and P.vivax.But more commonly in P. falciparum.Out of 36 severe thrombocytopenia 34 developed complicated malaria with significant p value indicating that patients with severe thrombocytopenia at the time of admission are 8.5 times more prone to develop complications when compared to mild and moderate thrombocytopenia.Patients who persisted to have thrombocytopenia even after 6th day of therapy, their mortality increased by 30%.