Table 1 Laboratory indicators of a poor clinical prognosis in severe malaria

Hyperparasitaemia:

> 250.000/ul or > 2% of infected erythrocytes in non-immunes and > 5% in semi-immune individuals

Schizonts of P. falciparum in peripheral blood

Mature pigmented parasites (> 20% of parasites)

Peripheral blood leukocytes

with ingested hemozoin (>5%)

Haemoglobin

< 5 g/dl or packed cell volume < 0.15

Polymorphonuclear leukocytes

> 12.000/ul

Coagulation disturbancies

Platelets < 50.000/ul

Prothrombin time prolonged > 3 sec

Prolonged partial thromboplastin time

Fibrinogen < 200 mg/dl

Low antithrombin III levels

Hypoglycaemia

< 2.2 mmol/l (< 40 mg/dl)

Acid-base disturbancies

Venous HCO3 < 15 mmol/l and/or arterial pH < 7.3

Lactate > 5 mmol/l

Kidney function

Serum creatinine > 3.0 mg/dl (> 265 mmol/l)

Blood urea nitrogen > 60 mg/dl

Liver function

More than 3-fold elevation of aminotransferases (AST, ALT)

Cerebrospinal fluid

High CSF lactic acid (> 6 mmol/l) and low CSF glucose concentration