Haematological Alterations in Initially Diagnosed and Relapse/Recurrent Cases of Malaria: A Comparative Study EC06-EC09
Dr. Sanjay Kaushik,
Associate Professor, Department of Pathology, Shri Mahant Indresh Hospital and Shri Guru Ram Rai,
Institute of Medical and Health Sciences (Sgrrim and Hs), Patel Nagar, Dehradun-248001, Uttarakhand, India.
Introduction: Malaria is endemic in India with an estimated 70-100 million cases each year. An alteration of haematological profile is one of the hallmarks in patients with malaria. A variety of haematological alterations like progressively increasing anaemia, leucocytosis or leucopenia, thrombocytopenia have been reported.
Aim: To evaluate and compare the effect of initially diagnosed cases and cases of relapse/ recurrence of malaria on haematological parameters and their correlation with Parasitic Index (PI).
Materials and Methods: This prospective study included 183 patients of initially diagnosed malaria cases and 64 follow-up cases of malaria. The diagnosis of malaria was confirmed on peripheral blood film and/or malaria antigen test. Complete blood counts were performed using automated Sysmex XN-1000. MP antigen test was done by Alere bioline SD malaria antigen kit. The Pearson’s Chi-square test was used for comparison of the patient’s data for association between distribution of severe anaemia in initially diagnosed cases of malaria and in cases with relapse/recurrence in relation to PI. The association of Grade III & IV thrombocytopenia in initially diagnosed cases of malaria and in cases with relapse/recurrence in relation to PI was evaluated using the paired Student’s t-test.
Results: Out of 183 initially diagnosed malaria cases, 163 cases had P. vivax and 20 cases had P. falciparum. All the cases of P. vivax and 75% of cases of P. falciparum had anaemia. All the cases had thrombocytopenia. Among 64 follow-up cases, 57 had P. vivax and 7 cases had P. falciparum infection. Approximately 50% cases of P. vivax and 40% cases of P. falciparum had normal Hb levels. Normal platelet counts were observed in 14% of P. vivax and 28.5% of P. falciparum cases. Majority of the cases (? 85%) of both the groups had PI =10.
Conclusion: Anaemia and thrombocytopenia are frequent findings in malaria with severity of thrombocytopenia related to PI. Thrombocytopenia is a constant finding in initially diagnosed cases of malaria but in cases of relapse/recurrence platelet counts may be normal.