Case Report
Profound thrombocytopenia in Plasmodium vivax malaria

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Abstract

In India, malaria is endemic and commonly caused by Plasmodium vivax and P. falciparum. Thrombocytopenia is a common finding in falciparum infection but is rare in P. vivax infection. We report profound thrombocytopenia in a 43-year-old female patient due to P. vivax infection. The platelet count was as low as 5 × 109/liter, such severe thrombocytopenia has never been reported in vivax malaria.

Introduction

Malaria caused by Plasmodium vivax and falciparum is endemic in many parts of India. Thrombocytopenia is a well known complication of both vivax and falciparum malaria but profound thrombocytopenia is more common in the latter. The mechanism of thrombocytopenia in malaria still remains to be elucidated.

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Case report

A 43-year-old female patient, resident of northern part of India, was admitted to our hospital with fever of 4 days duration. Fever was high grade of 40°C, intermittent with chills and rigors. No purpuric spots were seen on physical examination, tourniquet test was negative, and hepatosplenomegaly was present. There was no history of drug ingestion. Laboratory investigations done revealed: haemoglobin-9.6 gm%, WBC-15.0 × 109/liter with 55% neutrophils, 28% lymphocytes, 5% monocytes, and

Discussion

In the patient, laboratory investigations demonstrated anaemia and leucopenia besides severe thrombocytopenia. In patients of vivax malaria, thrombocytopenia is usually mild, although occasionally platelet counts may be severely depressed. The lowest ever reported platelet count with Plasmodium vivax infection is 22 × 109/liter (Anstey et al. 1992). The patient had a thrombocyte count of 5 × 109/liter. She had no bleeding manifestations. To the best of our knowledge this is the lowest ever

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