9606080651/653/654 STUDY OF HAEMATOLOGICAL PARAMETERS IN MALARIA
ABSTRACT
Malaria causing plasmodia are parasites of blood and hence induce haematological alterations. The haematological changes that have been reported to accompany malaria include anemia, thrombocytopenia and leucocytosis, leukopenia, mild to moderate atypical lymphocytosis, monocytosis, eosinophilia and neutrophilia.
INTRODUCTION
Malaria is a major health problem in India, being one of the biggest burdens in terms of morbidity and mortality among all infectious diseases. More than 100 countries in the world are considered malarious, and more than 2.4 billion of the world’s population is at risk. The worldwide annual incidence of malaria is estimated to be about 300-500 million cases. Malaria kills between 1.1 and 2.7 million people annually of which majority are children under five years.
Malaria causing plasmodia are parasites of blood and hence induce hematological alterations. The hematological changes that have been reported to accompany malaria include anemia, thrombocytopenia and leucocytosis, leucopenia, mild to moderate atypical lymphocytosis, monocytosis, eosinophilia and neutrophilia.3-8 Platelet abnormalities are both qualitative as well as quantitative
Thrombocytopenia is common occurrence in acute malaria and it is observed in vivax and falciparum malaria to varying degrees. Hepatic involvement in P. falciparum malaria is not an uncommon presentation and presence of jaundice (bilirubin >3mg/dl) is one of the indicators of severe malaria as defined by the WHO.
NEED OF THE STUDY
Various haematological findings can help in early diagnosis of malaria which is essential for timely and appropriate treatment which can limit the morbidity and prevent further complications.
OBJECTIVE
Malaria is transmitted by the female anopheles mosquito, causes clinical illness and pathological changes in various body organs with the parasites invading and multiplying in the circulating red blood cells. Malaria causes numerous hematological alterations of which anemia and thrombocytopenia are the most important.
Fever is most common symptom. Also chills and rigor, nausea and vomiting, headache are still the common symptoms of malaria. Even though malaria is commonly associated with thrombocytopenia, rash and petechial hemorrhages in the skin or mucous membranes are not the common presentation features.
METHODS
Following readings were noted
• Hemoglobin (HB%)
• HCT
• Total leukocyte count (TLC)
• Differential leukocyte
• Platelet count.
BIOCHEMICAL INVESTIGATION
Liver function test (LFT): The patient’s samples were processed for Liver function tests including-Serum Bilirubin, AST, ALT
Kidney function test (KFT):The patient’s samples were processed for Kidney function tests including-Serum creatinine and blood urea
PERIPHERAL BLOOD SMEAR EXAMINATION
Peripheral blood smear examination was done systematically under low, high and oil immersion of microscope for
• RBC morphology
• Total leukocyte count and differential count
• Platelet adequacy
• Type of malaria parasite
In anemic patients, most commonly RBC’s were Normocytic Normochromic followed by Microcytic Hypochromic. Microcytic Hypochromic blood picture was seen nearly equal in both falciparum and vivax infection.
BLOOD COUNT
Haemoglobin concentration
Majority of the patients undergo either mild (40%) or moderate degree (30%) of anemia. Hb Concentration <7 gm% and Haematocrit values less than 20 were seen in Falciparum infection.
Platelet count
Decreased platelet counts were a constant feature of both types of malaria with less than 1.5 lakhs/mm. Severe Platelet Reduction Decreased (<50,000) can be observed.
Total leucocyte count (TLC)
Majority of the patients have normal Total WBC count
CONCLUSION
Malaria is one of the most common infections in Indian Subcontinent. Malaria affects mostly adults with male predominance. Fever, Pallor and Splenomegaly are common clinical features in malaria. Malarial infection causes various haematological and biochemical changes.
Anaemia and thrombocytopenia of varying severity are most frequently observed haematological findings however bleeding manifestations are uncommon.
In a patient with febrile illness, observation of thrombocytopenia warrants careful search for malaria parasite. P. falciparum is associated with serious complications like Severe anemia, Malarial hepatitis and Renal failure hence P. falciparum infection on suspicion of complication should be further evaluated. Various haematological findings can help in early diagnosis of malaria which is essential for timely and appropriate treatment which can limit the morbidity and prevent further complications.