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Imported malaria is a major cause of thrombocytopenia in children presenting to the emergency department in east London


, : Imported malaria is a major cause of thrombocytopenia in children presenting to the emergency department in east London. British Journal of Haematology 129(5): 707-709

A retrospective study was conducted to determine the causes of thrombocytopenia in children presenting to the Emergency Department of Newham Hospital in East London, UK between January and December 2002. Sixty-five children (38 boys; aged 3-9 years) were included in the study. Malaria accounted for 46% (30 of 65) of all cases of thrombocytopenia and 61% (30 of 49) of infectious causes of thrombocytopenia. Plasmodium falciparum was the aetiological agent in 27 cases, Plasmodium vivax in two cases, and Plasmodium ovale in one case. Malaria was diagnosed in 29% (two of five), 61% (11 of 18), and 43% (17 of 40) children with platelet counts of <50x109/litre, 50-99x109/litre and 100-149x109/litre, respectively. The children with thrombocytopenia and malaria were non-white, with history of foreign travel in the past six months, and fever compared with thrombocytopenic children without malaria. Malaria was diagnosed in 30 of 33 children with thrombocytopenia and history of travel to a malaria-endemic country in the past six months, giving a positive predictive value of 91%. Three children with malaria and thrombocytopenia had negative results at initial screening. The findings indicate that children with thrombocytopenia and history of foreign travel have 91% risk of having malaria regardless of taking antimalarial prophylaxis. This is the first study to show that malaria is a significant cause of thrombocytopenia in children presenting to the emergency department. It is recommended that malaria should be considered in the differential diagnosis for any child with thrombocytopenia, especially if there is a history of recent foreign travel and/or fever, even if the initial malaria screening result is negative. In addition, blood samples with thrombocytopenia in the emergency department should undergo routine screening for malaria in hospitals catering to large multi-ethnic populations.

US$19.90

PMID: 15916695

DOI: 10.1111/j.1365-2141.2005.05522.x


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