a Department of Internal Medicine , Kasturba Medical College, Manipal Academy of Higher Education , Manipal , India.
b Department of Statistics , Prasanna School of Public Health, Manipal Academy of Higher Education , Manipal , Karnataka , India.
Pathog Glob Health. 2019 Mar;113(2):86-93. doi: 10.1080/20477724.2019.1600855. Epub 2019 Apr 9.
The association of hematological parameters especially platelet parameters with disease severity in malaria is poorly understood. We aimed to characterize the platelet parameters across Plasmodium falciparum and Plasmodium vivax malaria stratified by severity and to elucidate the potential role of platelet parameters to predict disease severity. Individuals > 18 years, of either gender with microscopically proven symptomatic malaria were prospectively enrolled between October 2014 and August 2016 in a tertiary center in Manipal, India. Severity of malaria was defined as per the WHO definition. Among 159 patients, 32 (20.1%) had severe malaria. 116 (73%) had infection with P. vivax, 37 (23%) P. falciparum and 6 mixed infection. Thrombocytopenia was seen in 32 (86.4%) of P. falciparum and 105 (90.5%) of P. vivax malaria cases. Patients with renal failure (p=0.02), shock (p=0.04) and liver dysfunction (p<0.001) had significantly lower platelet count compared to those who did not. Admission platelet count of 50,000 cell/mmhad a sensitivity and specificity of 65.6% and 70.6% respectively, to discriminate severe malaria. A plateletcrit of 0.05% had a sensitivity and specificity of 65.6 % and of 70.6% respectively. Thrombocytopenia was seen in 89.3% of malaria cases due to both P. vivax and P. falciparum. Platelet count and plateletcrit could be used as markers of disease severity. P. vivax malaria which has been traditionally regarded as 'benign' can be as sinister and menacing as P. falciparum malaria and hence warrants equal attention. Unnecessary transfusion of platelets should be avoided.
血小板参数与疟疾严重程度的相关性，特别是血液学参数与疟疾严重程度的相关性，目前了解甚少。本研究旨在对不同严重程度的恶性疟原虫和间日疟原虫疟疾患者的血小板参数进行特征描述，并阐明血小板参数预测疾病严重程度的潜在作用。2014 年 10 月至 2016 年 8 月，在印度曼尼帕尔的一家三级中心，前瞻性招募了 159 名年龄>18 岁的男女显微镜确诊的有症状疟疾患者。疟疾的严重程度按照世界卫生组织的定义来定义。在 159 例患者中，32 例（20.1%）为重症疟疾。116 例（73%）为间日疟原虫感染，37 例（23%）为恶性疟原虫感染，6 例为混合感染。在恶性疟原虫和间日疟原虫疟疾患者中，分别有 32 例（86.4%）和 105 例（90.5%）出现血小板减少症。与无肾功能衰竭、休克和肝功能障碍的患者相比，有肾功能衰竭（p=0.02）、休克（p=0.04）和肝功能障碍的患者血小板计数明显较低。入院时血小板计数为 50,000 细胞/mm3时，鉴别重症疟疾的敏感性和特异性分别为 65.6%和 70.6%。血小板crit为 0.05%时，敏感性和特异性分别为 65.6%和 70.6%。恶性疟原虫和间日疟原虫引起的疟疾患者中分别有 89.3%和 89.3%出现血小板减少症。血小板计数和血小板crit可作为疾病严重程度的标志物。传统上被认为“良性”的间日疟原虫疟疾可能与恶性疟原虫疟疾一样严重和危险，因此需要同等重视。应避免不必要的血小板输注。
