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

Hanson, Josh, Phu, Nguyen Hoan, Hasan, Mahatab Uddin, Charunwatthana, Prakaykaew, Plewes, Katherine, Maude, Richard J., Prapansilp, Panote, Kingston, Hugh W. F., Mishra, Saroj K., Mohanty, Sanjib, Price, Ric N., Faiz, M. Abul, Dondorp, Arjen M., White, Nicholas J., Hien, Tran Tinh and Day, Nicholas P. J. (2015). The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis. BMC Medicine,13(Article No. 97).

Document type: Journal Article
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IRMA ID 11381xPUB110
Title The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis
Author Hanson, Josh
Phu, Nguyen Hoan
Hasan, Mahatab Uddin
Charunwatthana, Prakaykaew
Plewes, Katherine
Maude, Richard J.
Prapansilp, Panote
Kingston, Hugh W. F.
Mishra, Saroj K.
Mohanty, Sanjib
Price, Ric N.
Faiz, M. Abul
Dondorp, Arjen M.
White, Nicholas J.
Hien, Tran Tinh
Day, Nicholas P. J.
Journal Name BMC Medicine
Publication Date 2015
Volume Number 13
Issue Number Article No. 97
ISSN 1741-7015   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84928568787
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
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 × 109/L) and 328 (50.7%) had a platelet count <50 × 109/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) × 109/L versus 50 (34 to 78) × 109/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 × 109/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.
Keywords Bleeding
Patient triage
Severe falciparum malaria
Thrombocytopenia
DOI http://dx.doi.org/10.1186/s12916-015-0324-5   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License
URL https://creativecommons.org/licenses/by/4.0/au


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