Saravu K, Docherla M, Vasudev A, Shastry B A
Kasturba Medical College, Manipal University, Karnataka, India.
Ann Trop Med Parasitol. 2011 Dec;105(8):593-8. doi: 10.1179/2047773211Y.0000000013.
Thrombocytopenia has been reported in the majority of malaria studies. Some but not all studies suggest the possible role of platelets in the pathology of severe malaria. We assess the association of admission platelet count with malaria complications and mortality in vivax and falciparum malaria.
This is a prospective, observational study of patients aged 18 years and above admitted in a tertiary care teaching hospital from August 2004 to July 2006 in Manipal, India. Malaria was diagnosed based on clinical features along with positive Quantitative Buffy Coat method (QBC MP) or thin blood smear examination (Giemsa stain). Platelet counts were measured using Coulter LH 756 Analyser. Thrombocytopenia was defined as a platelet count <150×10(9)/l.
A total of 131 consecutive patients were included. Sixty patients (46%) were infected with Plasmodium vivax and the rest with Plasmodium falciparum. Forty-six (35%) patients had non-severe and 24 (18%) had severe falciparum infection. The prevalence of thrombocytopenia was similar in vivax and falciparum malaria. Patients with severe falciparum malaria had a statistically significant lower platelet count (P = 0·01) compared to non-severe falciparum malaria. Severe malaria patients with renal failure (P = 0·02) or hyperparasitaemia (P = 0·03) had a statistically significant lower mean platelet count compared to non-severe falciparum malaria. Patients with involvement of more than one organ system had a lower mean platelet count compared to those with single organ involvement.
The incidence of thrombocytopenia was similar in vivax and falciparum malaria. The admission platelet count is significantly lower in patients who have hyperparasitaemia and acute renal failure compared to patients without complications.
在大多数疟疾研究中均报告有血小板减少症。一些（但并非全部）研究表明血小板在重症疟疾病理过程中可能发挥作用。我们评估间日疟和恶性疟患者入院时血小板计数与疟疾并发症及死亡率之间的关联。
这是一项对2004年8月至2006年7月在印度马尼帕尔一家三级护理教学医院收治的18岁及以上患者进行的前瞻性观察研究。根据临床特征以及定量血沉棕黄层法（QBC MP）阳性或薄血涂片检查（吉姆萨染色）诊断疟疾。使用库尔特LH 756分析仪测量血小板计数。血小板减少症定义为血小板计数<150×10⁹/L。
共纳入131例连续患者。60例（46%）感染间日疟原虫，其余感染恶性疟原虫。46例（35%）患者为非重症恶性疟，24例（18%）为重症恶性疟感染。间日疟和恶性疟中血小板减少症的患病率相似。与非重症恶性疟相比，重症恶性疟患者的血小板计数在统计学上显著更低（P = 0.01）。与非重症恶性疟相比，伴有肾衰竭（P = 0.02）或高疟原虫血症（P = 0.03）的重症疟疾患者的平均血小板计数在统计学上显著更低。累及多个器官系统的患者的平均血小板计数低于单个器官受累的患者。
间日疟和恶性疟中血小板减少症的发生率相似。与无并发症的患者相比，高疟原虫血症和急性肾衰竭患者入院时的血小板计数显著更低。
