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

BMC Medicine

Nicholas PJ Day⁶  Tran Tinh Hien⁴  Nicholas J White⁶  Arjen M Dondorp⁶  M Abul Faiz¹  Ric N Price⁶  Sanjib Mohanty⁷  Saroj K Mishra⁷  Hugh WF Kingston²  Panote Prapansilp³  Richard J Maude⁶  Katherine Plewes²  Prakaykaew Charunwatthana²  Mahtab Uddin Hasan⁷  Nguyen Hoan Phu⁴  Josh Hanson⁵ 

[1] Dev Care Foundation, Dhaka, Bangladesh;Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn, Thailand;Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia;Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Chittagong Medical College, Chittagong, Bangladesh

关键词: Thrombocytopenia;    Severe falciparum malaria;    Patient triage;    Bleeding;   

Others  :  1174825
DOI  :  10.1186/s12916-015-0324-5

 received in 2014-12-04, accepted in 2015-03-13,  发布年份 2015

【 摘 要 】

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, r_s = −0.28, P = 0.003), the degree of microvascular sequestration (measured with orthogonal polarizing spectral imaging, r_s = −0.31, P = 0.001) and disease severity (the number of World Health Organization severity criteria satisfied by the patient, r_s = −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.

【 授权许可】

   
2015 Hanson et al.; licensee BioMed Central.

【 图 表 】

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