Clinical characteristics of thrombocytopenia in tropical diseases and management in resource-limited settings

Platelets play a central role in the pathogenesis of tropical infectious diseases. Infections such as malaria, dengue, and leptospirosis are often accompanied by thrombocytopenia. While the platelet count is typically monitored as a measure of thrombocytopenia, other platelet indices may better determine bleeding severity. Platelet dysfunction in these conditions requires a nuanced approach to management. Prophylactic platelet transfusions have shown limited efficacy in preventing hemorrhagic complications and carry additional risks. These include transfusion-transmitted infections, logistical challenges, and the high cost of platelet concentrates. Herein, we review current insights into platelet biology in major tropical infections, examine the varied mechanisms underlying thrombocytopenia in these conditions, and discuss the latest evidence on transfusion guidelines. We also propose evidence-based approaches to thrombocytopenia management and platelet transfusion. We aim to summarize approaches that may improve care for populations disproportionately affected by tropical infectious diseases in resource-limited settings.