Sikandar Hayat Khan, Muhammad Farooq.
Vivax Malaria; Hematological Changes: A Study At Karachi.
Professional Med J Jan ;24(6):859-64.

Background: The primary health care physician is usually perplexed with regards to selection of initial therapy for patients presenting with fever. Some degrees of hematological changes do exist in most patients with malaria. How often these changes do exist with malaria in our set up? And whether these changes are due to associated fever or actually resulting because of malaria. Objective: 1-To measure the frequency of abnormal hematological changes in malaria patients in our set up. 2-To compare the hematological parameters among subjects with laboratory proven malaria, fever but no malaria diagnosis and healthy controls. Design: Cross-sectional analysis. Place and duration of study: This study was carried out from May 2010 to Dec- 2010 at department of medicine PNS SHIFA, and departments of pathology PNS SHIFA and RAHAT, Karachi. Subjects and methods: Subjects with history of fever and a clinical suspicion of malaria were recruited from primary physician’s OPD along with healthy age and sex-matched control. First, the frequencies of various abnormal findings in hematological parameters were measured in subjects diagnosed to have malaria. Later, group-1: [Malaria (Laboratory positive) (n=74)], Group-2: [Fever (Laboratory negative) (n=104)] and group-3: [Age and sex matched controls (n=54)] were evaluated by one way ANOVA followed by post-hoc comparisons for significant differences among groups. Blood complete picture were measured by automated hematology analyzer (Specifications: CELTAC - alpha, MEK-6410 K). Malaria parasite presence was confirmed by both slide examination technique and immune-chromatographic (ICT) testing. Main outcome measures-Hemoglobin, white blood cells (WBC), platelets, PDW, % neutrophil. Results- 21.62 % cases from malaria had anemia, while the occurrence of leucopenia was 62.16%. This leukpenia was associated with relative neutrophil excess (63.51%). Thrombocytopenia was the most consistent finding among our studied subjects (97.30%). The difference between the three groups were significant for platelets [Group-1, Malaria (Laboratory positive) group= 86.42 (95%CI: 78.43-94.41)] [Group 2, Fever (Laboratory negative) group = 192.47 (95%CI: 177.69-207.25)] and (Group-3, Age and sex matched control group=278.89 (95%CI: 254.16-303.62)] {p<0.001}, and WBC [Group-1, Malaria (Laboratory positive) group= 5.55 (95%CI: 5.08-6.01)] [Group 2, Fever (Laboratory negative) group = 6.68 (95%CI: 6.14-7.20)] and (Group-3, Age and sex matched control group=8.78 (95%CI: 8.01-9.55)] {p<0.001}. The results for % neutrophil and PDW were also significant, but post-hoc comparison did not show significant differences between groups thus differentiating a case of malaria from non-malaria fever or control. Conclusion: Malaria due to Plasmodium vivax is associated with thrombocytopenia and leucopenia in our set up. Moreover, the associated hematological parameters including % neutrophil and PDW may help in augmenting a clinical diagnosis of malaria.

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