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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/36463
Title: The clinical implications of thrombocytopenia in adults with severe falciparum malaria: A retrospective analysis
Authors: Josh Hanson
Nguyen Hoan Phu
Mahtab Uddin Hasan
Prakaykaew Charunwatthana
Katherine Plewes
Richard J. Maude
Panote Prapansilp
Hugh W.F. Kingston
Saroj K. Mishra
Sanjib Mohanty
Ric N. Price
M. Abul Faiz
Arjen M. Dondorp
Nicholas J. White
Tran Tinh Hien
Nicholas P.J. Day
Mahidol University
Menzies School of Health Research
UCL
Chittagong Medical College
Nuffield Department of Clinical Medicine
Chulalongkorn University
Dev Care Foundation
Keywords: Medicine
Issue Date: 24-Apr-2015
Citation: BMC Medicine. Vol.13, No.1 (2015)
Abstract: © Hanson et al.; licensee BioMed Central. 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.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84928568787&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/36463
ISSN: 17417015
Appears in Collections:Scopus 2011-2015

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