title: Severe malarial thrombocytopenia: a risk factor for mortality in Papua, Indonesia.
abstract: BACKGROUND
  The significance of thrombocytopenia to the morbidity and mortality of malaria is poorly defined. We compared the platelet counts and clinical correlates of patients with and those without malaria in southern Papua, Indonesia.
  
  
  METHODS
  Data were collated on patients presenting to a referral hospital between April 2004 and December 2012.
  
  
  RESULTS
  Platelet measurements were available in 215 479 patients (23.4%), 66 421 (30.8%) of whom had clinical malaria. Patients with Plasmodium falciparum monoinfection had the lowest platelet counts and greatest risk of severe thrombocytopenia (platelet count, <50,000 platelets/µL), compared with those without malaria (adjusted odds ratio [OR], 6.03; 95% confidence interval [CI], 5.77-6.30]). The corresponding risks were 5.4 (95% CI, 5.02-5.80) for mixed infections, 3.73 (95% CI, 3.51-3.97) for Plasmodium vivax infection, and 2.16 (95% CI, 1.78-2.63) for Plasmodium malariae infection (P<.001). In total, 1.3% of patients (2701 of 215 479) died. Patients with severe malarial anemia alone (hemoglobin level, <5 g/dL) had an adjusted OR for death of 4.93 (95% CI, 3.79-6.42), those with severe malarial thrombocytopenia alone had an adjusted OR of 2.77 (95% CI, 2.20-3.48), and those with both risk factors had an adjusted OR of 13.76 (95% CI, 10.22-18.54; P<.001).
  
  
  CONCLUSIONS
  Severe thrombocytopenia identifies both children and adults at increased risk of death from falciparum or vivax malaria, particularly in those with concurrent severe anemia.
authors.affiliation: Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Lampah
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Lee Kong Chian School of Medicine, Nanyang Technological University Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Tsin W
authors.initials: TW
authors.lastname: Yeo
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne Victorian Cytology Service, Carlton, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Malloy
authors.affiliation: Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority.
authors.forename: Enny
authors.initials: E
authors.lastname: Kenangalem
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Division of Medicine, Christchurch Hospital, New Zealand.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Douglas
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Donny
authors.initials: D
authors.lastname: Ronaldo
authors.affiliation: Rumah Sakit Mitra Masyarakat, Timika, Papua.
authors.forename: Paulus
authors.initials: P
authors.lastname: Sugiarto
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Simpson
authors.affiliation: Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority.
authors.forename: Jeanne Rini
authors.initials: JR
authors.lastname: Poespoprodjo
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Division of Medicine, Royal Darwin Hospital, Darwin.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
authors.forename: Ric N
authors.initials: RN
authors.lastname: Price
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010961:Plasmodium; D010976:Platelet Count; D011446:Prospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality* / Q000469:parasitology; D055815:Young Adult
keywords: Indonesia; Plasmodium falciparum; Plasmodium malariae; Plasmodium vivax; malaria; platelets; thrombocytopenia