Association between thrombocytopaenia and Plasmodium falciparum infection in Ghana

Malaria caused by Plasmodium falciparum is a major global health challenge, often causing significant haematological disturbances. These changes, such as anaemia and thrombocytopenia, reflect the host's response to infection and can influence disease severity and diagnosis. This study aimed to evaluate haematological alterations in patients with P. falciparum malaria and to identify factors associated with P. falciparum infection across different localities in Ghana. A comparative cross-sectional study was conducted from June to September 2025 across three sites in Ghana (Ashaiman, Kwesimintsim, and Kyebi). The study involved 388 participants, comprising P. falciparum malaria-positive individuals and malaria-negative using convenience sampling technique. Malaria was diagnosed using standard microscopy, and haematological parameters (haemoglobin, platelet count, white blood cell count, and erythrocyte sedimentation rate [ESR]) were measured using automated analysers and the Westergren method. Data on demographic characteristics were obtained from laboratory records. Statistical analysis was performed in R software version 4.5.1, utilizing non-parametric tests, chi-square tests, and binary logistic regression to assess predictors of malaria. Model performance was evaluated using ROC curves. P-value was set at P < 0.050. While overall ESR, WBC counts, and haemoglobin levels showed no significant differences between non-malaria and P. falciparum malaria, site-specific variations were observed. Malaria cases in Kwesimintim had higher ESR, and those in Kyebi had lower haemoglobin compared to their non-malaria counterparts. The most consistent finding was thrombocytopaenia; platelet counts were significantly lower in malaria cases across all subgroups, with an overall median of 152.0 × 10⁹/L versus 234.0 × 10⁹/L in controls (p < 0.001). In regression analysis, thrombocytopenia showed the strongest association with P. falciparum malaria (adjusted Odds Ratio = 11.8; 95% CI: 6.18-24.7; p < 0.001). A model incorporating haematological indices demonstrated superior predictive performance (AUC = 77.6%) compared to a model based on sociodemographic factors alone (AUC = 57.9%). Furthermore, increasing parasite density was associated with higher ESR, lower platelet counts, and reduced haemoglobin, with more pronounced effects in females. This study confirms that thrombocytopaenia is associated with P. falciparum malaria. The integration of routine haematological parameters, particularly platelet count, into diagnostic algorithms can significantly improve P. falciparum malaria risk stratification and clinical diagnosis, offering a cost-effective advantage in resource-limited settings where automated haematology analysers are increasingly available.