Malaria is a life-threatening parasitic disease caused by Plasmodium species and transmitted through the bite of female Anopheles mosquitoes. Among the species, Plasmodium vivax predominates in Asia, whereas Plasmodium falciparum is more common in Africa . Severe malaria continues to be a major cause of morbidity and mortality worldwide. While P. falciparum is often associated with fatal outcomes, P. vivax can also result in life-threatening complications. Vulnerable populations include children under five, pregnant women, and elderly individuals, whose immune systems render them more susceptible to rapid disease progression and complications such as severe anemia.

Hematological disturbances are common complications of malaria and play a key role in clinical severity. Thrombocytopenia, defined as a platelet count below 150 × 10³/μL, is frequently observed in malaria patients . The mechanisms contributing to low platelet counts are multifactorial, including peripheral platelet destruction, splenic sequestration, bone marrow suppression, platelet consumption in disseminated intravascular coagulation, immune- mediated destruction, oxidative stress, and abnormal interactions with parasitized red blood cells .

Beyond platelet count, alterations in platelet indices—Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Large Cell Ratio (P-LCR), and Plateletcrit (PCT)—reflect changes in platelet morphology and function .

Elevated MPV indicates increased release of young, larger platelets from the bone marrow in response to peripheral loss, whereas PDW reflects variability in platelet size due to anisocytosis. PCT, representing the total platelet mass, decreases with thrombocytopenia and reflects overall platelet availability.

Automated hematology analyzers now allow rapid measurement of these indices, which may serve as adjunctive markers for disease severity, prognosis, and early identification of high-risk malaria patients.

Assessing platelet parameters alongside standard diagnostic methods could enhance early detection, guide clinical management, and provide a better understanding of malaria pathophysiology .

METHODS

A retrospective observational study was conducted at the Central Clinical Laboratory, PDU Hospital, Rajkot, India, to evaluate platelet counts and platelet indices in patients diagnosed with malaria. Data were collected for all laboratory-confirmed malaria cases between January 2025 and December 2025.

Inclusion Criteria

• Patients of all ages with confirmed malaria infection by peripheral blood smear examination and/or rapid diagnostic test (RDT).
• Both Plasmodium vivax and Plasmodium falciparum infections, including mixed infections.
• Patients with complete laboratory records of platelet parameters, including platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), and Plateletcrit (PCT).

Exclusion Criteria

• Patients with pre-existing hematological disorders, such as idiopathic thrombocytopenic purpura or leukemia.
• Patients with concurrent infections or conditions known to affect platelet counts (e.g., dengue, HIV, hepatitis, sepsis).
• Patients on medications affecting platelet function or count (e.g., chemotherapy, antiplatelet therapy).
• Incomplete or missing laboratory

A total of 100 malaria-positive patients met the inclusion criteria, comprising 85 adults and 15 pediatric patients aged 0–12 years. Among them, 66% were infected with P. vivax, 30% with P. falciparum, and 4% had mixed infections, indicating predominance of P. vivax in the study population.

Platelet parameters were measured using an automated hematology analyzer, ensuring standardized and reproducible results. Continuous variables were expressed as mean ± standard deviation. Plateletcrit, reflecting total platelet mass, was significantly reduced (mean 0.072 ± 0.05), consistent with malaria- associated thrombocytopenia.All patient identifiers were anonymized to maintain confidentiality. Automated assessment of platelet indices allowed evaluation of their potential as adjunctive markers for malaria severity and disease progression.

Figure 1: Age and Gender Distribution of Malaria Cases by Species:

Table 1: Age and Gender Distribution of Malaria Cases by Species:

Figure 2 : Marked Reduction in Plateletcrit (PCT) Among Plasmodium vivax Positive Cases:

Figure 3 : Reduction in Plateletcrit (PCT) Among Plasmodium falciparum Positive Cases:

CONCLUSION

Platelet indices demonstrate significant potential in assessing malaria severity. An increase in Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW), coupled with a decrease in Plateletcrit (PCT) and platelet count, serves as a reliable predictor of disease severity. These alterations are especially prominent in conditions characterized by increased peripheral platelet destruction, such as severe malaria, underscoring their clinical utility for early diagnosis and prognosis.

Acknowledgments:

The authors sincerely thank the staff of the Central Clinical Laboratory, PDU Hospital, Rajkot, for their support in data collection and technical assistance. We also acknowledge the contributions of the laboratory personnel who ensured accurate measurement of platelet indices and maintained patient confidentiality throughout the study.

Conflicts of Interest:

The authors declare no conflicts of interest related to this study.

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