Diagnostic and prognostic value of thrombocytopenia severity in Sudanese children with Falciparum malaria

Abstract

Malaria remains one of the most significant global public health challenges, with more than 200 million clinical cases worldwide each year. Falciparum malaria accounting for up to 87.6 % of malaria cases in Sudan. Platelets abnormalities as thrombocytopenia especially severe thrombocytopenia have been associated with mortality in patients with P. falciparum infection. The aim of this study was to study the relationships between thrombocytopenia and their severity with falciparum malaria severity, parasitemia and parasite count. This study was case-control hospital based study conducted among 200 Sudanese children admitted to Wad Medani Pediatric Hospital, Wad Medani, Sudan during period September to December 2018. The study population was divided into two groups. Group 1 (UM) was 100 children with uncomplicated falciparum malaria. Group 2 (SM) was 100 children with severe falciparum malaria were diagnosed by WHO criteria. A 2.5 ml venous blood sample was collected from each children. The malaria parasitemia was determined from thick blood films using plus system. The parasite count (% of parasitized red cells counting) was counted from thin blood film. Platelets count was determined using the Sysmex XP 300 N automated hematology analyzer (Sysmex, Kobe, Japan) and confirmed and assessed using stained thin blood film. The data were analyzed using SPSS software (V 20.0) and Stat disk software (V 13.0). The mean age and male: female ratio of Group 1 (UM) were 8.83 ± 4.20 years and 1:1.22 respectively and for Group 2 (SM) were 8.63 ± 3.40 years and 1.56:1 respectively. Group 2 (61 %) associated with thrombocytopenia (mean PLTs 160.91 ± 186.24 × 10 9 /) more than Group 1 (25 %) (mean PLTs 221.10 ± 98.69 × 10 9 /L) (P value = 0.000). The mild, moderate and severe thrombocytopenia account for 19 %, 5 % and 1 % respectively among Group 1; and 22 %, 28 % and 11 % respectively among Group 2 (P value 0.003). Malaria thrombocytopenia was significantly associated (P value = 0.000) and negatively correlated (P value = 0.000; r =-0.341) with malaria parasitemia. The mean parasite count in malaria thrombocytopenia (0.77 ± 0.51 %) was higher than malaria without thrombocytopenia (0.53 ± 0.36 %) (P value 0.000). Thrombocytopenia severity was significantly positive correlated with malaria parasitemia (r = 258; P value = 0.017) and parasite count (r = 0.229; P value = 0.034). The study concluded that the severe thrombocytopenia associated commonly with severe falciparum malaria and falciparum malaria hyperparasitemia.