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Severe Malarial Thrombocytopenia: A Risk Factor for Mortality in Papua, Indonesia

Lampah, Daniel A., Yeo, Tsin W., Malloy, Michael, Kenangalem, Enny, Douglas, Nicholas M., Ronaldo, Donny, Sugiarto, Paulus, Simpson, Julie A., Poespoprodjo, Jeanne R., Anstey, Nicholas M. and Price, Ric N. (2015). Severe Malarial Thrombocytopenia: A Risk Factor for Mortality in Papua, Indonesia. Journal of Infectious Diseases,211(4):623-634.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 2
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IRMA ID 84473306xPUB4
Title Severe Malarial Thrombocytopenia: A Risk Factor for Mortality in Papua, Indonesia
Author Lampah, Daniel A.
Yeo, Tsin W.
Malloy, Michael
Kenangalem, Enny
Douglas, Nicholas M.
Ronaldo, Donny
Sugiarto, Paulus
Simpson, Julie A.
Poespoprodjo, Jeanne R.
Anstey, Nicholas M.
Price, Ric N.
Journal Name Journal of Infectious Diseases
Publication Date 2015
Volume Number 211
Issue Number 4
ISSN 0022-1899   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84922454551
Start Page 623
End Page 634
Total Pages 12
Place of Publication United States
Publisher Oxford University Press
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
The significance of thrombocytopenia to the morbidity and mortality of malaria is poorly defined. We compared the platelet counts and clinical correlates of patients with and those without malaria in southern Papua, Indonesia.

Methods
Data were collated on patients presenting to a referral hospital between April 2004 and December 2012.

Results
Platelet measurements were available in 215 479 patients (23.4%), 66 421 (30.8%) of whom had clinical malaria. Patients with Plasmodium falciparum monoinfection had the lowest platelet counts and greatest risk of severe thrombocytopenia (platelet count, <50 000 platelets/µL), compared with those without malaria (adjusted odds ratio [OR], 6.03; 95% confidence interval [CI], 5.77–6.30]). The corresponding risks were 5.4 (95% CI, 5.02–5.80) for mixed infections, 3.73 (95% CI, 3.51–3.97) for Plasmodium vivax infection, and 2.16 (95% CI, 1.78–2.63) for Plasmodium malariae infection (P < .001). In total, 1.3% of patients (2701 of 215 479) died. Patients with severe malarial anemia alone (hemoglobin level, <5 g/dL) had an adjusted OR for death of 4.93 (95% CI, 3.79–6.42), those with severe malarial thrombocytopenia alone had an adjusted OR of 2.77 (95% CI, 2.20–3.48), and those with both risk factors had an adjusted OR of 13.76 (95% CI, 10.22–18.54; P < .001).

Conclusions
Severe thrombocytopenia identifies both children and adults at increased risk of death from falciparum or vivax malaria, particularly in those with concurrent severe anemia.
Keywords malaria
Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
thrombocytopenia
Indonesia
platelets
DOI http://dx.doi.org/10.1093/infdis/jiu487   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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