Grant Murewanhema
Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Parirenyatwa Group of Hospitals, Ministry of Health and Child Care, Harare, Zimbabwe; Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe
Tapuwa Carol Musiniwa
Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe; Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
Maxwell Takura Chimhina
Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe; Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
Simbarashe Madombi
Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Parirenyatwa Group of Hospitals, Ministry of Health and Child Care, Harare, Zimbabwe; Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe
Munyaradzi Innocent Nyakanda
Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe; Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
Mugove Gerald Madziyire
Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe; Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
Abstract
Malaria in pregnancy is associated with significant morbidity and mortality, and requires early diagnosis and intervention. Plasmodium falciparum is responsible for 98% of malaria cases in Zimbabwe and causes the most severe disease. Abnormal haematological parameters are a frequent finding in patients with malaria; however, they are rarely the sole presenting feature. We present the case of a 32-year-old woman in her fifth pregnancy, with a history of one previous caesarean section, who presented for caesarean section and was incidentally noted to have severe thrombocytopenia. Subsequent investigations at a tertiary institution revealed a pancytopenia with thrombocytopenia as the most prominent feature in an asymptomatic patient. The unavoidable caesarean section done under platelet cover was eventful, with severe intractable haemorrhage necessitating an emergency hysterectomy. However, the patient made a full recovery with antimalarial treatment and blood product transfusions. This case is presented to illustrate the need to consider malaria as a differential diagnosis in pregnant patients from malaria-transmitting areas who have thrombocytopenia. Previous studies have shown that thrombocytopenia can be a predictor of malaria in patients who present with fever, and a marker of disease severity, but has no utility in prognostication and follow-up.