Background: Thrombocytopenia is a common hematological abnormality associated with Plasmodium falciparum malaria, yet its prevalence and relationship with parasite density vary across endemic regions. This study assessed the prevalence and severity of thrombocytopenia among confirmed malaria patients and examined its association with malaria parasite density at the Seventh-day Adventist (SDA) Hospital, North Gbawe. Accra Methods: A cross-sectional study was conducted using secondary laboratory data from January to June 2025. A total of 138 confirmed P. falciparum cases were selected through systematic random sampling. Data on age, sex, platelet count, and parasite density were extracted. Descriptive statistics, chi-square tests, and Pearson correlation analysis were performed using SPSS version 26. Statistical significance was set at p < 0.05. Results: Of the 138 malaria-positive patients (50% male; mean age 31.9 ± 18.0 years), thrombocytopenia was present in 72%, while 27% had normal platelet counts and 1% had thrombocytosis. Mild, moderate, severe, and critical thrombocytopenia constituted 43%, 39%, 14%, and 4% of cases, respectively. Malaria severity grades included low (48%), moderate (14%), high (16%), and very high (22%) parasite densities. A significant association was found between malaria grade and thrombocytopenia severity (χ² = 28.774, p = 0.001). Additionally, a significant negative correlation was observed between parasite count and platelet count (r = – 0.268, p = 0.001), indicating a proportional decline in platelet levels with increasing parasitemia. Conclusion: Thrombocytopenia is highly prevalent among P. falciparum malaria patients, and its severity correlates strongly with parasite density. These findings support the use of platelet count as a valuable adjunct marker for assessing malaria severity, particularly in resource-limited settings. Further research is needed to explore the immunopathological mechanisms and prognostic implications of thrombocytopenia in malaria.