Malaria is a common communicable disease and is a major public health problem in India, resulting in high morbidity and mortality. Splenomegaly and thrombocytopenia are common findings in malaria. Thrombocytopenia is present in 80% of the patients with malaria and some studies show that thrombocytopenia in malaria closely correlates with the degree of parasitemia. However, thrombocytopenia is not included in the WHO criteria for severe malaria. This study aims to find whether thrombocytopenia can be an indicator of severe malaria as it is a hematological parameter that is present even before other features of severe malaria set in. It also aims to find the association between degree of thrombocytopenia and splenomegaly in malaria.

Severe malaria is defined according to the WHO guidelines. The presence of one or more of the following clinical or laboratory features classifies the adult patient as suffering from severe malaria. Clinical features like a) impaired consciousness or unrousable coma, b) prostration (generalized weakness so that the patient is unable to walk or sit up without assistance), c) multiple convulsions (>2 episodes in 24hours), d) deep breathing, respiratory distress (acidotic breathing), e) circulatory collapse or shock (systolic BP <70mmHg), f) clinical jaundice plus evidence of other vital organ dysfunction, g) hemoglobinuria, h) abnormal spontaneous bleeding, i) pulmonary edema (radiological). Laboratory findings like a) hypoglycemia (blood glucose <40mg/dl), b) metabolic acidosis (plasma bicarbonate <15mmol/l), c) normocytic anemia (Hb <5g/dl, packed cell volume <15%), d) hemoglobinuria, e) hyperlactataemia (lactate >5mmol/l), f) renal impairment (serum creatinine >3mg/dl), g) hyperparasitemia (2%/100,000/μl in low intensity transmission areas or >5% or 250,000/μl in high intensity transmission areas).

Thrombocytopenia by definition is an abnormally low amount of platelets, less than 1,50,000 per microliter of blood.