Prognostic value of thrombocytopenia in African children with falciparum malaria.

Gérardin, Patrick; Rogier, Christophe; Ka, Amadou Sidy; Jouvencel, P.; Brousse, Valentine; Imbert, Patrick

doi:10.4269/ajtmh.2002.66.686

Cited by 151 publications

(153 citation statements)

References 24 publications

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“…The reason for rare bleeding episodes in malaria may be the hypersensitive platelets, which are thought to enhance haemostatic responses which have been reported despite thrombocytopenia 11,12,13 . In a study by Chandra 14 the MPV of more than 8fL was a comparatively more sensitive indicator for vivax malaria (70.8%) than falciparum (50.4%).…”

Section: Discussionmentioning

confidence: 99%

Platelet profile and its correlation to paediatric patients with acute malaria in a tertiary care hospital

Joshi¹,

Gamit

2016

Sri Lanka J Child Health

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Section: Discussionmentioning

confidence: 99%

Platelet profile and its correlation to paediatric patients with acute malaria in a tertiary care hospital

Joshi¹,

Gamit

2016

Sri Lanka J Child Health

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“…Some studies have identifi ed a relationship between the decrease in PC and the appearance of clinical complications, such as anemia, respiratory distress syndrome and cerebral malaria 37 . We found that the patients with severe (25,000-49,999 platelets/µL) or profound thrombocytopenia (<25,000 platelets/µL) had more pathological changes in their clinical status compared with the patients without thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombocytopenia can be interpreted as evidence of damage and has been associated with clinical complications and high parasitemia 9,12,37 . However, some studies have suggested that thrombocytopenia has a protective effect, which reduces the probability of red blood cell aggregation 28 or mediates parasite destruction.…”

Section: Discussionmentioning

confidence: 99%

Platelet profile is associated with clinical complications in patients with vivax and falciparum malaria in Colombia

Martinez-Salazar

Tobón-Castaño

2014

Rev. Soc. Bras. Med. Trop.

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Introduction: Thrombocytopenia is a common complication in malaria patients. The relationship between abnormal platelet profi le and clinical status in malaria patients is unclear. In low and unstable endemic regions where vivax malaria predominates, the hematologic profi les of malaria patients and their clinical utility are poorly understood. The aim of this study was to characterize the thrombograms of malaria patients from Colombia, where Plasmodium vivax infection is common, and to explore the relationship between thrombograms and clinical status. Methods: Eight hundred sixty-two malaria patients were enrolled, including 533 (61.8%) patients infected with Plasmodium falciparum, 311 (36.1%) patients infected with Plasmodium vivax and 18 (2.1%) patients with mixed infections. Results: The most frequently observed changes were low platelet count (PC) and high platelet distribution width (PDW), which were observed in 65% of patients; thrombocytopenia with <50,000 platelets/µL was identifi ed in 11% of patients. Patients with complications had lower PC and plateletcrit (PT) and higher PDW values. A higher risk of thrombocytopenia was identifi ed in patients with severe anemia, neurologic complications, pulmonary complications, liver dysfunction, renal impairment and severe hypoglycemia. The presence of thrombocytopenia (<150,000 platelets/µL) was associated with a higher probability of liver dysfunction. Conclusions: Young age, longer duration of illness and higher parasitemia are associated with severe thrombocytopenia. Our study showed that thrombocytopenia is related to malaria complications, especially liver dysfunction. High PDW in patients with severe malaria may explain the mechanisms of thrombocytopenia that is common in this group of patients.

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“…It has also been reported that fibrin, monocytes, and platelets accumulate in the brain of patients who died from CM* abstract 39 indicating that these vessels display a proinflammatory/ -coagulant environment. Actually, platelets may contribute to malaria pathogenesis through exposure of PS and release of pro-inflammatory mediators among other mechanisms 20 ; besides, one study concluded that trombocytopenia have predictive value for mortality in P. falciparum-infected patients 12 .…”

Section: The Tissue Factor Model For Malaria Pathogenesismentioning

confidence: 99%

“…The main argument that supports this notion is the fact that the vast majority, perhaps all patients with mild and severe malaria, present elevated levels of D-dimers20, a specific marker of plasmin-mediated fibrin proteolysis in vivo 23 . Finally, it has been reported that hemostatic alterations correlate with parasitemia, thrombocytopenia, and/or severity of P. falciparum infection in a number of studies; in addition, antiparasitic treatment halts the coagulation disorder and improves clinical outcome [12][13][14][15][16][17][18][19][20] .Therefore, it is plausible that hemostatic alterations play a role in the disease progression and organ failure observed in malaria 16,20 .More recently, it has been demonstrated that P. falciparum-parasitized RBC (pRBC) induce tissue factor (TF) expression in the microvascular EC in vitro, and support the assembly of multimolecular coagulation complexes 10 . TF is the clotting initiator 24-26 and a structural member of the cytokine receptor family, which signifies the expansion of the adaptive immune system in vertebrates, indicating a close connection of the coagulation pathways with the host response to infection 27 .…”

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confidence: 99%

Does activation of the blood coagulation cascade have a role in malaria pathogenesis?

Francischetti

2008

Trends in Parasitology

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Plasmodium falciparum infection is often associated with a procoagulant state. Recent identification of tissue factor (TF) in the brain endothelium of patients who died from cerebral malaria casts new light in our understanding of the coagulation disorder found in P. falciparum infection. It has also been revealed that parasitized red blood cells (pRBC) support assembly of multimolecular coagulation complexes. In this article, the role of TF expression by the endothelium and amplification of the coagulation cascade by pRBC and/or activated platelets-particularly at sequestration sitesis discussed as crucial events in mounting and sustaining a coagulation-inflammation cycle that contributes to organ dysfunction and coma in P. falciparum malaria. Blood coagulation and malariaMalaria caused by P. falciparum remains a highly endemic disease; it has been estimated that at least one million deaths occur every year. Children are at high risk, and often severe malaria (severe anemia or cerebral malaria [CM]) is the cause of death in this population 1-4. P. falciparum infection is associated with sequestration 5 -8 , endothelial cell (EC) activation 8-10, increase in inflammatory cytokines 3 , 11, and activation of the coagulation cascade 12 -20. Despite several papers devoted to the coagulation disorder in malaria-many of them published during the 1970s and 1980s (reviewed in Ref. 20)-the mechanism that triggers and propagates the coagulation activation in P. falciparum infection has remained elusive. These studies, however, demonstrated that bleeding and/or hemorrhage are typically not present, although laboratory tests indicate a certain degree of in vivo blood coagulation activation 12 -20 . Accordingly, prothrombin time (PT) and partial thromboplastin time (PTT) are close to normal values or prolonged, whereas thrombin-antithrombin complex (TAT) (which indicates in vivo thrombin formation) and D-dimers (which are a marker of in vivo fibrinolysis) are often elevated, and thrombocytopenia is a usual finding 12 -21 . This laboratory profile is compatible with disseminated intravascular coagulation (DIC), which is diagnosed according to a score defined by the International Society of Thrombosis and Haemostasis (ISTH) 22 . The scoring system takes into account i) platelet count, ii) elevated fibrin related markers, iii) prolonged prothrombin time, and iv) fibrinogen level 22 23 . Depending on the score punctuation, levels < 5 are suggestive of non-overt (compensated) DIC while scores > or = 5 are compatible with overt (decompensated) DIC. Bleeding is more common in overt DIC, but it is not needed for the formal diagnosis 22 23. In other words, absence of bleeding in P. falciparum-infected patients does not exclude the presence of DIC in this same population; actually, most of these patients meet the criteria for DIC as defined above 22 . Unfortunately, absence of bleeding is often mistakenly regarded as the reason why DIC is supposedly not present in malaria. Further, some reports do not support the view that coa...

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Prognostic value of thrombocytopenia in African children with falciparum malaria.

Cited by 151 publications

References 24 publications

Platelet profile and its correlation to paediatric patients with acute malaria in a tertiary care hospital

Platelet profile and its correlation to paediatric patients with acute malaria in a tertiary care hospital

Platelet profile is associated with clinical complications in patients with vivax and falciparum malaria in Colombia

Does activation of the blood coagulation cascade have a role in malaria pathogenesis?

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