Skip to main content Skip to main navigation menu Skip to site footer
Original Research Articles
Published: 2020-04-29

Impact of Sever Plasmodium falciparum infection on Platelets Parameters among Sudanese children Living in Al-Jazira State

Platelets count, Platelets indices, Thrombocytopenia, Falciparum malaria, Sudanese children.


Background: Falciparum malaria remains one of the most global infection among children particularly in communities with poor resources. Falciparum malaria associated with several hematological changes that affect the major blood cell lines such as platelets lead to platelets parameters (platelets count and indices) abnormalities.

Objectives: The aim of this study was to evaluate the effects of falciparum malaria on platelets parameters (platelets count and indices) among Sudanese children. In addition to study relationships and correlation between platelets parameters and malaria parasitemia and parasite count.

Materials and Methods: A case control study was conducted in Wad Medani Pediatric Hospital in collaboration with Faculty of Medical laboratory Sciences, University of Gezira, Sudan among 100 children with severe falciparum malaria (mean age 8.63 ± 3.40 years; 61% males), 100 children with uncomplicated falciparum malaria (mean age 8.83 ± 4.20 years; 45% males) and 100 children with normal healthy children controls (mean age 10.08 ± 3.58 years; 50% males). Parasitemia and parasite count (%) was determined directly from thick and thin blood films respectively. The platelets parameters (platelets count and indices) measured by using Sysmex XP 300 N automated analyzer, and platelets count was confirmed and assessed using stained thin blood film. SPSS software (V 20.0) and Stat disk software (V 13.0) were used for data analysis.

Results: 72 % of severe falciparum malaria (SM) have hyperparasitemia, while 18 % among uncomplicated falciparum malaria (UM). The thrombocytopenia account for 43 % (SM: 30.5 %; UM: 12.5 %), low PCT account for 35.5 % (SM: 27 %; UM: 8.5 %) and high PDW account for 46.5 % (SM: 23.5 %; UM: 23 %) in falciparum malaria cases. The mean PLTs count and PDW were statistically significantly differences between falciparum malaria cases and normal healthy control (P value 0.000 and 0.008 respectively). The mean PLTs count and PCT in severe falciparum malaria cases were lower than uncomplicated falciparum malaria cases (P value 0.005 and 0.000 respectively). The PLTs count and PCT had significant negative correlation within malaria parasitemia (P value 0.000; r -0.286; P value 0.004; r -0.205 respectively) and malaria parasite count (P value 0.000; r -0.450; P value 0.000; r -0.270 respectively).

Conclusion: The study concluded that thrombocytopenia, low PCT and high PDW were observed as most platelets parameters changes in falciparum malaria. PLTs count along with PCT to be recommended as hematological diagnostic markers and prognostic tool to assess the disease severity and to improve the management of falciparum malaria among patients.


  1. Recker M, Bull PC, Buckee CO. Recent advances in the molecular epidemiology of clinical malaria. F1000 Research. 2018;7:1159
  2. World Health Organization. Severe and complicated malaria. (4th ed). Trop Med Int Health 2014. In press.
  3. Lampah DA, Yeo TW, Malloy M, Kenangalem E, Douglas NM, Ronaldo D et al. Severe Malarial Thrombocytopenia: A Risk Factor for Mortality in Papua, Indonesia. The Journal of Infectious Diseases. 2015;211: 623–34
  4. World Health Organization. 11th World malaria report. WHO in Geneva:2018; pp XII, XIII 44, 45
  5. Mohamedahmed KA; Mustafa RE; Abakar AD; Nour BYM. Evaluation of Neutrophil Lymphocyte Ratio (NLR) in Sudanese Children with Falciparum Malaria. IJAHMR. 2019;3 (5): 1-6
  6. Antwi-Baffour S, Kyeremeh R, Buabeng D, Adjei JK, Aryeh C, Kpentey G, Seidu MA. Correlation of malaria parasitaemia with peripheral blood monocyte to lymphocyte ratio as indicator of susceptibility to severe malaria in Ghanaian children. Malaria journal. 2018 ;17(1):1-9
  7. Prasad PL, Rai PL, Hussain MS. A study of haematological profile of malaria in a tertiary care centre of western Uttar Pradesh, India. Int J Contemp Pediatr. 2018;5:1115-9
  8. Mohamedahmed KA, Abakar AD, Ahmed MO, Mukhtar MM, Nour BYM. The Role of TNF-α Levels as Predictive Diagnostic Biomarker Among Children with Severe Falciparum Malaria in Endemic Area in Sudan. IJAHMR. 2019; 3(7): 1-6
  9. Menendez C, Fleming AF, Alonso PL. Malaria-related anaemia. Parasitol Today. 2000;16:469–76
  10. Suh KN, Kain KC, Keystone JS. Malaria. Canadian Medical Association Journal. 2004;170(11): 1693-1703
  11. Lacerda MV, Mourão MP, Coelho HC, Santos JB. Thrombocytopenia in malaria: who cares?. Memorias do Instituto Oswaldo Cruz. 2011;106:52-63
  12. Warrell DA, Gilles,HM . Essential Malariology. (4th edition). Arnold, a member of the Hodder Headline Group, London: 2000;191-205
  13. Leal-Santos FA, Silva SB, Crepaldi NP, Nery AF, Martin TO, Alves-Junior ER, Fontes CJ. Altered platelet indices as potential markers of severe and complicated malaria caused by Plasmodium vivax: a cross-sectional descriptive study. Malaria journal. 2013;12(1):462.
  14. Kotepui M, Phunphuech B, Phiwklam N, Chupeerach C, Duangmano S. Effect of malarial infection on haematological parameters in population near Thailand-Myanmar border. Malaria journal. 2014;13(1):218.
  15. Gérardin P, Ka AS, Imbert P. Thrombocytopenia as Additional Marker of Severity in African Children with Plasmodium Falciparum Malaria. J Infect Dis Pathog. 20118;1(1):1-5
  16. World Health Organization. Guidelines for The Treatment of Malaria. (3rd ed). WHO in Geneva: 2015;pp 24, 32, 48, 60, 72.
  17. World Health Organization. Basic Malaria Microscopy. (2nd ed). WHO in Geneva: 2010;pp 18, 22, 33, 42, 74, 75
  18. Bain BJ, Bates I, Laffan M, Lewis M, editors. (11th ed). Chapter 2, British: Elsevier Ltd:2011; pp 394-397
  19. Roll Back Malaria in Sudan. Sudan Malaria Treatment Protocol 2017. Federal Ministry of Health. 2017;pp: 8-40.
  20. Roberts D, Matthews G. Risk factors of malaria in children under the age of five years old in Uganda. Malaria journal. 2016;15(1):246
  21. National Malaria Control Programme. Five Years Strategies Plan for the National Malaria Control Programme, Sudan 2011–2015. Federal Ministry of Health: 2010;pp 9.
  22. Madukaku CU, Chimezie OM, Chima NG, Hope O, Simplicius DIN. Assessment of the haematological profile of children with malaria parasitaemia treated with three different artemisinin-based combination therapies. Asian Pac J Trop Dis. 2015;5(6):448-53
  23. Birhanu M, Asres Y, Adissu W, Yemane T, Zemene E, Gedefaw L. Hematological parameters and hemozoin-containing leukocytes and their association with disease severity among malaria infected children: a cross-sectional study at Pawe General Hospital, Northwest Ethiopia. Interdisciplinary perspectives on infec diseases. 2017;1-7
  24. Frimpong A, Kusi KA, Tornyigah B, Ofori MF, Ndifon W. Characterization of T cell activation and regulation in children with asymptomatic Plasmodium falciparum infection. Malaria journal. 2018;17(1):263
  25. Elsayid M, Elbasheer MA, Othman AA, Belal RH, Elfaki TE. Estimation of complete blood count and platelets indices in Sudanese patients with malaria. American Journal of Research Communication. 2017;5(1):29-38
  26. Casals-Pascual C, Kai O, Newton CRJC, Peshu N, Roberts DJ. Short Report: Thrombocytopenia in Falciparum Malaria is Associated with High Concentration of IL-10. Am. J. Trop. Med. Hyg., 2006;75(3):434-6
  27. Maina RN, Walsh D, Gaddy C, Hongo G, Waitumbi J, Otieno L, et al. Impact of Plasmodium falciparum infection on haematological parameters in children living in Western Kenya. Malaria Journal. 2010;9(3): S4
  28. Martínez-Salazar EL, Tobón-Castaño A. Platelet profile is associated with clinical complications in patients with vivax and falciparum malaria in Colombia. Revista da Sociedade Brasileira de Medicina Tropical. 2014;47 (3): 341-9
  29. Erhabor O, Otunuya O, Erhabor T, Knox VD, Adias TC. Anaemia and Thrombocytopenia among Children of African Descent with Acute Plasmodium Falciparum Malaria in Sokoto, North Western Nigeria.2018;4(1).51
  30. Salih MM, Eltahir HG, Abdallah TM, Elmahdi T, Khamis AH, Malik EM, Adam I. Haematological parameters, haemozoin-containing leukocytes in Sudanese children with severe Plasmodium falciparum malaria. J Infect Dev Ctries.2018;12(4): 273-78
  31. AreÂvalo-Herrera M, Rengifo L, Lopez-Perez M, Arce-Plata MI, GarcõÂa J, Herrera S. Complicated malaria in children and adults from three settings of the Colombian Pacific Coast: A prospective study. PLoS ONE. 2017;12 (9): e0185435
  32. Chhawchharia R, Kolhe S, George R, Lahiri KR. Clinical and Hematological Changes in Childhood Malaria in India. IOSR Journal of Dental and Medical Sciences. 2016;15(7): 86-90
  33. Graham SM, Chen J, Chung DW, Barker KR, Conroy AL, Hawkes MT, Namasopo S, Kain KC, López JA, Liles WC. Endothelial activation, haemostasis and thrombosis biomarkers in Ugandan children with severe malaria participating in a clinical trial. Malaria journal. 2016;15(1):56
  34. Sahoo AK, Das KK. Pulmonary complications in falciparum malaria in a tertiary care center in costal Andhra Pradesh. IOSR-JDMS. 2013;4:82-5
  35. Gerardin P, Rogier C, Ka AS, Jouvencel P, Brousse V, Imbert P. Prognostic Value of Thrombocytopenia in African Children with Falciparum Malaria. Am. J. Trop. Med. Hyg.2002; 66(6): 686-91
  36. Ladhani S, Lowe B, Cole AO, Kowuondo K, Newton CR. Changes in white blood cells and platelets in children with falciparum malaria: relationship to disease outcome. British journal of haematology. 2002 Dec;119(3):839-47
  37. Wassmer SC, Taylor TE, Rathod PK, Mishra SK, Mohanty S, Arevalo-Herrera M et al. Investigating the Pathogenesis of Severe Malaria: A Multidisciplinary and Cross-Geographical Approach. Am. J. Trop. Med. Hyg. 2015;93(3):42-56
  38. Deroost K, Pham TT, Opdenakker G, Van den Steen PE. The immunological balance between host and parasite in malaria. FEMS Microbiology Reviews. 20016;40(2): 208-57
  39. Abdelnassir MA, Hafiz AH, Gad Allah M, Mohammed SE. Hematological Changes in Sudanese Patients with Falciparum Malaria Attending Elnihoud Teaching Hospital. Sudan Journal of Medical Sciences. 2019;14 (1): 24-30

How to Cite

Mohamedahmed, K. A., Ahmed, Z. A., Nour, B. Y. M., Abakar, A. D., & Babker, A. M. (2020). Impact of Sever Plasmodium falciparum infection on Platelets Parameters among Sudanese children Living in Al-Jazira State. International Journal of Clinical and Biomedical Research, 6(2), 5–9.