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Research ArticleThrombocytopenia in Plasmodium vivax Malaria:How Significant?

Arti Muley, Jitendra Lakhani, Saurabh Bhirud, and Abhinam Patel

SBKS MI & RC, Sumandeep Vidyapeeth, Piparia, Vadodara 390024, India

Correspondence should be addressed to Arti Muley; [email protected]

Received 20 February 2014; Revised 30 April 2014; Accepted 29 May 2014; Published 17 June 2014

Academic Editor: Georges Snounou

Copyright 2014 Arti Muley et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction. Thrombocytopenia is frequently noticed with P. falciparum malaria but is less reported and studied with P. vivax.Materials and Methods. The study was conducted in the Department of Medicine, SBKS MI & RC, Pipariya. We included patientswho were diagnosed with vivax malaria. The data regarding their clinical and hematological profile was collected and analysed.Result. A total of 66 patients were included. 42 (63%) had platelet count1.2 gm/dL, 15 (35.71%) had jaundice (s. bilirubin > 1.2), 2 (4.76%) had altered sensorium, 6 (14.28%) had ARDS, 2 needed ventilatorsupport, and 1 expired. Amongst those with normal platelet count, 5 (20.83%) had anemia and 1 had jaundice whereas none hadelevated s. creatinine, altered sensorium, or lung involvement. Conclusion. Thrombocytopenia is now being seen more commonlywith vivax malaria. Patients with platelet count

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Table 1: Basic characteristics of the two groups (1 lac/cumm).

Platelet count1 lac/cumm

Age (years) 25 7 27 6 (P value 0.13)Males 26 (61.9%) 37 (63.79%)Females 16 (38.09%) 21 (36.2%)RBS (gm%) 115.08 16.77 110.90 21.4 (P value 0.38)BP (systolic, mmHg) 115.90 12.22 118.5 10.09 (P value 0.17)

to find out the status of thrombocytopenia in P. vivax in adultpopulation and find if it has any association with severity.

2. Methodology

It was a prospective cohort study. Prior permission for thestudy was taken from institutional ethical committee. Allpatients diagnosed with malaria on peripheral smear wereenrolled for the study.The patients with falciparum infectioneither alone or in combination with vivax or who did not givewritten informed consent were excluded. The patients withunderlying disease which may cause similar complicationslike dengue and sepsis were also excluded.

All patients were subject to the routine laboratory investi-gations like hematological profile (complete blood count withplatelet count), urine routine microscopy, renal function test,serum electrolytes, liver function test, blood sugar levels, andchest X-ray. Viral markers were done in patients with icterusto rule out viral hepatitis. Ultrasonography was also done tostudy the size and echo texture of the liver and gall bladder,intrahepatic or extrahepatic bile duct dilatation, and signsof portal hypertension. Other special investigations like CTscan of head and arterial blood gas analysis (ABG) were donewhen indicated. Presenting symptoms and signs were notedalong with the information on complications developed.

Thrombocytopenia was defined as platelet count1.2mg/dL (OR 4.28), and 8(19.04%) had blood urea >40mg/dL (OR 2.3). These wereseen in much less proportion in the other group. Similarly,7.14%, 11.90%, and 14.28% had ARDS, hepatomegaly, andsplenomegaly, respectively, in the

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Table 3: Difference in results of investigations between the two groups.

Investigation 1 lac/cum valueHb (gm%) 10.54 2.26 10.94 2.53 0.54TLC (per cumm) 6338 3543 6987 3691 0.48Platelet count (per cumm) 67,619 28,106 2,07,958 121983

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may be used as a marker of severity and increased chances ofcomplications. It identifies the set of patients who will needaggressive management.

5. Conclusion

The trend of disease with P. vivax malaria is changing.Similar incidence of thrombocytopenia is now seen in vivaxand falciparum malaria patients. All complications seen infalciparum positive cases are being seen in vivax positivecases also.Thrombocytopeniamay not be a cause ofmortalityby itself, but it can be a marker of increased severity and needof aggressive management. There is a need to reexamine theclinical spectrum and severity of P. vivax malaria especiallyin the light of thrombocytopenia. We also recommendformulation of separate guidelines formanagement ofP. vivaxwith platelet count

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