Background: Malaria is a very common infectious disease and multiple studies have reported thrombocytopenia as one of the common haematological abnormalities associated with it Increasing association between the disease severity, its pathology  and platelet indices is being suggested . This study aimed to attempt an association between the myriad manifestations of malaria, their severity and correlation with platelet count.

Methods: This study was carried out as an observational study on patients admitted with the diagnosis of Malaria in the general medicine wards of Pt BRAM Medical College, Raipur between 2005-2008. Diagnosis of malaria was considered if either of the investigations-peripheral smear, antigen based rapid diagnostic card tests or quantitative buffy coat method (QBC) were positive. Coulter LH 756 was used to measure platelet counts. Platelet counts less than 1,50,000/mm3 were taken to be abnormal.  Biochemistry and other pertaining investigations were done to ascertain the presence of any other complications. All the parameters at the time of hospitalization were considered for data analysis

Results: Of the 105 patients included in the study,  majority were of male gender (82%) with an average mean age of 38 years.

50 % of patients had tested positive for plasmodium Falciparum, 48% had Plasmodium Vivax and 2% had mixed Plasmodium Vivax and Falciparum infections.

As per the WHO criteria on management of severe malaria (2008), only 14% of patients infected with plasmodium falciparum had severe disease while the majority (36%) had non-severe disease. Both Plasmodium Vivax and Falciparum had equal incidence of thrombocytopenia but  significantly lower platelet count were seen in patients with mixed Pl Vivax and Pl Falciparum infections and in those cases who met any one or more of the  WHO criteria for severe malaria, though not all associations were statistically significant.

Conclusions: In our study group, Thrombocytopenia was a very common haematological abnormality . However a statistically significant association between severity of platelet count and the species of malaria (Vivax vs Falciparum) was not seen. However, lower platelet counts were seen in patients meeting one or more of the WHO criteria of severe malaria. This association was most significant when renal impairment and parasitemia were taken into consideration. However, since a single reading of different parameters at the time of inclusion  was taken, this association could not be definitely proved and thus needs further larger and prospective studies before appropriate  conclusions can be drawn.

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Dr Renymol B

Associate Professor, Department of Medicine, Government TD Medical College, Alappuzha, India