QUESTION:

Why are platelets low in malaria infections? Why is there no internal bleeding in malaria?

ANSWER:

Platelets are low especially with P. falciparum infections, but also potentially with high-burden P. vivax infections. This is probably from sequestration in blood vessels and spleen. Actually, there is life threatening bleeding associated with severe cerebral malaria from this stasis and sequestration in the brain. Similarly, enlargement of the spleen leaves it susceptible to rupture, which would lead to critical internal bleeding.