Hematological Alterations in Plasmodium falciparum and Plasmodium vivax Malaria Patients Admitted to a Tertiary Care HospitalHospital

Abstract

Background and objectives: Malaria causes a wide spectrum of hematological and clinical manifestations. This study aimed to identify the alterations in the clinical and hematological parameters in patients infected with Plasmodium vivax, Plasmodium falciparum, and mixed species. Methods: The study included 126 smear-positive malaria cases, and various hematological parameters were studied. Results: The frequency of P. vivax, P. falciparum, and mixed species was 53.9%, 36.5%, and 9.6%, respectively. Anemia (hemoglobin <11 gm%) was seen in 79.3% of the cases, and severe anemia (hemoglobin <5g%) was detected in 27.7% of the cases. A decrease in red blood cell count was observed in 67% of P. falciparum and 47% cases of P. vivax cases. Increased red cell distribution width and erythrocyte sedimentation rate were seen in 81% and 78% of the cases, respectively. Leukocytosis and leucopenia were detected in 15% and 16% of all malaria cases, respectively. Thrombocytopenia was associated with 78% of cases infected with P. vivax. The degree of anemia was correlated with the parasite load, and the degree of parasitemia was correlated with the extent of thrombocytopenia. There were also significant variations in the mean corpuscular volume, hematocrit, mean corpuscular hemoglobin concentration, and platelet counts among malarial species (p<0.05). Conclusion: Malaria is frequently associated with anemia, thrombocytopenia, and leukopenia. Thrombocytopenia is mostly associated with P. vivax infection. On contrary, leukopenia is more prevalent in P. falciparum, followed by P. vivax and mixed parasitemia. sodium citrate vacutainers (for ESR estimation). Hemoglobin (Hb), hematocrit (HCT), red blood cell (RBC) indices such as mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total leucocyte count, absolute leucocyte count, platelet count, red cell distribution width (RDW), and mean platelet volume (MPV) were measured using an automated coulter hematology analyzer. Thick and thin smears were prepared from the venous blood samples. Thin blood smears were prepared using fresh blood samples stained with Leishman stain and were used for microscopy, differential leucocyte count, species identification, and estimation of parasitemia. The level of parasitemia (%) in thin blood smears was estimated by counting the number of infected RBCs per 1,000 RBCs. A minimum of 200 thick blood films were examined before issuing a negative report (13). Data were analyzed in SPSS (version 16) using the Chi-square test. The statistical significance level was set to 0.05. RESULTS Of 126 cases, 68(54%) were infected with P. vivax, 46 (36%) were infected with P. falciparum, and 12 (10%) had mixed infection. The majority of samples were taken from patients aged 10-20 years (31%). In males, the rate of infection with P. vivax (67.6%) and P. falciparum (78.2%) was higher than in females. However, in the case of mixed infection, both sexes were affected equally (6 cases). Severe anemia (Hb < 5g/dl) was only present in infections caused by P. falciparum and mixed species. Mild to moderate anemia was only observed in samples infected with P. vivax (Table 1). In the majority of cases, RBCs were normocytic normochromic (55.5%) and microcytic hypochromic (35%). A microcytic hypochromic and normocytic normochromic blood smear was equally present in both samples infected with P. falciparum and P. vivax. The RBC count was decreased in 78 cases (62%) and normal in the rest of the cases. In addition, a significant reduction of RBC count was seen in the cases of mixed infections (92%), followed by P. falciparum