Association between Parasite Density and Thrombocytopenia in Plasmodium falciparum Malaria: A Cross-Sectional Study in Ghana

Abstract:Background: Thrombocytopenia is a common hematological abnormality associated withPlasmodium falciparum malaria, yet its prevalence and relationship with parasite density varyacross endemic regions. This study assessed the prevalence and severity of thrombocytopeniaamong confirmed malaria patients and examined its association with malaria parasite density atthe Seventh-day Adventist (SDA) Hospital, North Gbawe. AccraMethods: A cross-sectional study was conducted using secondary laboratory data from Januaryto June 2025. A total of 138 confirmed P. falciparum cases were selected through systematicrandom sampling. Data on age, sex, platelet count, and parasite density were extracted.Descriptive statistics, chi-square tests, and Pearson correlation analysis were performed usingSPSS version 26. Statistical significance was set at p < 0.05.Results: Of the 138 malaria-positive patients (50% male; mean age 31.9 ± 18.0 years),thrombocytopenia was present in 72%, while 27% had normal platelet counts and 1% hadthrombocytosis. Mild, moderate, severe, and critical thrombocytopenia constituted 43%, 39%,14%, and 4% of cases, respectively. Malaria severity grades included low (48%), moderate(14%), high (16%), and very high (22%) parasite densities. A significant association was foundbetween malaria grade and thrombocytopenia severity (χ² = 28.774, p = 0.001). Additionally, asignificant negative correlation was observed between parasite count and platelet count (r = –0.268, p = 0.001), indicating a proportional decline in platelet levels with increasing parasitemia.Conclusion: Thrombocytopenia is highly prevalent among P. falciparum malaria patients, andits severity correlates strongly with parasite density. These findings support the use of plateletcount as a valuable adjunct marker for assessing malaria severity, particularly in resource-limitedsettings. Further research is needed to explore the immunopathological mechanisms andprognostic implications of thrombocytopenia in malaria.