Prevalence and Clinical Significance of Thrombocytopenia in Malaria: A Systematic Review and Meta-analysis

Abstract

Background: Thrombocytopenia is a common hematological abnormality in malaria and has been increasingly recognized as a potential diagnostic and prognostic indicator. However, reported estimates of its prevalence and clinical significance vary widely across studies and settings. Objective: This systematic review and meta-analysis aimed to determine the pooled prevalence of thrombocytopenia among patients with laboratory-confirmed malaria and to evaluate its clinical significance in relation to disease severity, complications, and outcomes. Methods: A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted for English-language studies published up to March 2026. Observational studies reporting platelet count data or extractable thrombocytopenia prevalence were included. A random-effects meta-analysis with Freeman–Tukey double arcsine transformation was used to estimate pooled prevalence. Heterogeneity was assessed using Cochran’s Q, I², and τ² statistics. The review protocol was registered in PROSPERO (CRD420261347334). Results: Twenty-two studies were included in the systematic review, and 15 studies comprising 2,183 malaria patients were included in the meta-analysis. The pooled prevalence of thrombocytopenia was 73.1% (95% CI: 65.7%–79.5%) with substantial heterogeneity (I² = 91.7%). Subgroup analysis showed prevalence estimates of 76.8% in Plasmodium falciparum, 68.4% in Plasmodium vivax, and 72.5% in mixed infections, with no statistically significant differences. Narrative synthesis indicated that lower platelet counts were associated with severe malaria, higher parasitemia, organ dysfunction, and increased mortality risk, while clinically significant bleeding was uncommon. Conclusion: Thrombocytopenia is highly prevalent in malaria and is more strongly associated with disease severity than bleeding risk. Platelet count may serve as a useful adjunct marker for diagnosis and clinical monitoring, particularly in endemic and resource-limited settings.