Thrombocytopenia in childhood malaria with special reference to P. vivax monoinfection: A study from Bikaner (Northwestern India)

• Published in: Platelets (Edinburgh) Vol. 23; no. 3; pp. 211 - 216
• Main Authors: Tanwar, Gajanand Singh, Khatri, Punam Chand, Chahar, Chandra Kumar, Sengar, Ghanshyam Singh, Kochar, Abhishek, Tanwar, Gayatri, Chahar, Shaifali, Khatri, Nimish, Middha, Sheetal, Acharya, Jyoti, Kochar, Sanjay Kumar, Pakalapati, Deepak, Garg, Shilpi, Das, Ashis, Kochar, Dhanpat Kumar
• Format: Journal Article
• Language: English
• Published: England Informa UK, Ltd 01.05.2012; Taylor & Francis
• Subjects: Adolescent; Child; Child, Preschool; Female; Hemorrhage - blood; Hemorrhage - epidemiology; Hemorrhage - etiology; Humans; India - epidemiology; Infant; Infant, Newborn; Malaria, Falciparum - blood; Malaria, Falciparum - complications; Malaria, Falciparum - epidemiology; Malaria, Vivax - blood; Malaria, Vivax - complications; Malaria, Vivax - epidemiology; Male; mixed malaria; Plasmodium falciparum; Plasmodium vivax; platelet; Platelet Count; Prospective Studies; severe malaria; thrombocytopenia; Thrombocytopenia - blood; Thrombocytopenia - epidemiology; Thrombocytopenia - etiology; India
• ISSN: 0953-7104; 1369-1635
• DOI: 10.3109/09537104.2011.607520

Thrombocytopenia is commonly seen in Plasmodium vivax malaria, but its prognostic value has not been addressed in children. This prospective study included 676 admitted children of malaria [Plasmodium falciparum (Pf) monoinfection 262, Plasmodium vivax (Pv) monoinfection 380, and mixed (Pf + Pv) infection 34], in which thrombocytopenia (platelet count <150 × 103/mm3 on admission) was found in 442 (65.38%) children [Pf monoinfection 55.3% (145/262), Pv monoinfection 73.16% (278/380), and mixed infection 55.88% (19/34)]. The association of thrombocytopenia was statistically significant with Pv monoinfection [73.16% (278/380)] in comparison to either Pf monoinfection [55.34% (145/262); odds ratio (OR) = 2.199 (95% confidence interval (CI) 1.577-3.068), p < 0.0001] or mixed infection [55.88% (19/34); OR = 2.152 (95%CI 1.054-4.394), p = 0.032]. In Pv monoinfection, thrombocytopenia was highest in 0-5 years age group and subsequently decreased with advancing age, whereas in Pf monoinfection it was reverse. Severe thrombocytopenia (platelet count <20 × 103/mm3) was present in 16.52% (73/442) children [Pv monoinfection 21.58% (60/278) and Pf monoinfection 8.97% (13/145)]. The risk of developing severe thrombocytopenia was also highest in Pv monoinfection [15.79% (60/380)] in comparison to Pf monoinfection [10.59% (13/262); OR = 3.591 (95%CI 1.928-6.690), p < 0.0001]. Bleeding manifestations were associated in 21.27% (94/442) children [Pf monoinfection 9.92% (26/262), Pv monoinfection 16.58% (63/380), and mixed malaria 14.71% (5/34)]. All the children having bleeding manifestations had thrombocytopenia but low platelet counts were not always associated with abnormal bleeding. The association of severe malaria was significantly more among children having Pv monoinfection with platelet counts <20 × 103/mm3 [OR = 2.569 (95%CI 1.196-5.517), p < 0.014] with specificity of 88.3% and positive predictive value of 85%. Till today, thrombocytopenia is not included in severe malaria criterion described by WHO, but when platelet counts <20 × 103/mm3, we advocate it to include as one of the severe malaria criteria.