HEMATOLOGICAL CHANGES IN COMPLETE BLOOD PICTURE IN PAEDRIATRIC PATIENTS OF MALARIA CAUSED BY PLASMODIUM VIVAX AND FALCIPARUM
AbstractBackground: Malaria is a major health problem and one of the major killers in paediatric population particularly in the developing world. High mortality is usually compounded by various haematological complications if left untreated. Their identification as risk factors for progression to severe disease may make the basis for optimal management of malaria. This study was conducted to determine various changes in the complete blood picture caused by malaria and to compare the severity of these changes among the prevalent species of plasmodia. Methods: It was cross sectional study conducted in paediatric ward of Civil Hospital, Dow University of Health Sciences, Karachi over a period of six months. Children aged >2 months to 15 years, of either sex, with fever above 101ºF in the preceding 72 hours with positive malaria parasite on peripheral blood smear were included in the study. Children already on anti-malarial treatment and long standing antibiotics, having co-morbidities like immune-compromised states, haemolytic disease or with any other haematological disorder were excluded from the study. Blood was tested for anaemia, leukopenia, leukocytosis, and thrombocytopenia. Data analysis was done via SPSS-15.0. Results: Out of 374 children half were under 5 years of age with mean age of 66.7±46.8 months, 50.8% were female with male to female ratio of 1:1.03. Overall 364 (97.3%) children had anaemia with mean haemoglobin level of 11.7±6 g/dl. Overall mean WBC count was 10443±154 per cubic millimetre. Leukopenia was found in 39% cases. Mean platelets count of enrolled children was 69451±648 cubic millimetre and 51.3% cases had mild thrombocytopenia. Anaemia (p=0.012), leukopenia (p=0.001) and thrombocytopenia (p=0.004) were significantly more common in falciparum as compared to vivax malaria. Conclusion: We concluded that malaria frequently causes severe anaemia, leukopenia and thrombocytopenia in children. P. falciparum is the species more responsible for these changes.Keywords: Malaria, Anaemia, leukopenia, thrombocytopenia, complete blood picture,Karachi
Borton C. Malaria. [Online]. [cited 2013 Mar 28]. Available from: URL: http://www.patient.co.uk/doctor/malaria.
Jamal MM, Ara J, Ali N. Malaria in paediatric age group: a study of 200 cases. Pak armed forces Med J 2005;55(1):74–7.
Murtaza G, Memon IA, Nonari AK. Malaria prevalence in sindh. Med Channel 2004;10(2):41–2.
Nizamani A, Kalar NA, Khushk IA. Burden of malaria in Sindh, Pakistan: a two years surveillance report. J Liaquat Uni Med Health Sci 2006;5(2):76–83.
Abro AH, ustadi AM, younis NJ, abdou AS, AL Hamed D, Saleh AA. Malar and hematological changes. Pak J Med Sci 2008;24:287–91.
Taha K, Zein-El-Dine S, Idress M, Maakboul G, baidas G. hematological changes in malaria: relation of plasmodium species. Kuwait Med J 2007;39:262–67.
Bashawri LA, Mandil AA, Bahnassy AA, Ahmed MA. Malaria: hematological aspects. Ann Saudi Med 2002;22(5-6):372–6.
Akbar JU. Malaria in children at a children hospital. J Coll Phys surg pak 2002;7(3):20–2.
Taylor WR, Widjaja H, Basri H, Ohrt C, Taufik T, Tjitra E, et al: Changes in the total leukocyte and platelet counts in Papuan and non Papuan adults from northeast Papua infected with acute Plasmodium vivax or uncomplicated Plasmodium falciparum malaria. Malar J 2008;7:259.
Johnson-Taylor WL, Fisher RA, Hubbard VS, Starke-Reed P, Eggers PS. The change in weight perception of weight status among the overweight: comparison of NHANES III (1988-1994) and 1999-2004 NHANES. Int J Behav Nutr Phys Act 2008;5:9.
Hanscheid T, Langin M, Lell B, Potschke M, Oyakhirome S, Kremsner PG, et al. Full blood count and haemozoin-containing leukocytes in children with malaria: diagnostic value and association with disease severity. Malar J 2008;7:109.
Gerardin P, Rogier C, Ka AS, Jouvencel P, Brousse V, Imbert P. Prognostic value of thrombocytopenia in African children with falciparum malaria. Am J Trop Med Hyg 2002;66(6):686–91.
Kumar A, Shashirekha. Thrombocytopenia--an indicator of acute vivax malaria. Indian J Pathol Microbiol 2006;49(4):505–8.
McKenzie FE, Prudhomme WA, Magill AJ, Forney JR, Permpanich B, Lucas C, et al. White Blood Cell Counts and Malaria. J Infect Dis 2005;192(2):323–30.
Tanwar GS, Khatri PC, Chahar CK, Sengar GS, Kochar A, Tanwar G, et al. Thrombocytopenia in childhood malaria with special reference to P. vivax monoinfection: A study from Bikaner (Northwestern India). Platelets 2012;23(3):211–6.
Ladhani S, Lowe B, Cole AO, Kowuondo K, Newton CR. Changes in white blood cells and platelets in children with falciparum malaria: relationship to disease outcome. Br J Haematol 2002;119(3):839–47.
Kochar DK, Das A, Kochar A, Middha S, Acharya J, Tanwar GS et al: Thrombocytopenia in Plasmodium falciparum, Plasmodium vivax and mixed infection malaria: a study from Bikaner (Northwestern India). Platelets 2010;21(8):623–7.
Olliaro P, Djimdé A, Dorsey G, Karema C, Martensson A, Ndiaye JL, et al. Hematologic parameters in paediatric uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa. Am J Trop Med Hyg 2011;85(4):619–25.
Shiff C, Checkley W, Winch P, Prenji Z, Minjas J, Lubeqa P. Changes in weight gain and anaemia attributable to malaria in Tanzanian children living under holoendemic conditions. Trans R Soc Trop Med Hyg 1996;90(3):262–5.
Sowunmi A, Akindele JA, Balogun MA. Leukocyte counts in falciparum malaria in African children from an endemic area. Afr J Med Med Sci 1995;24(2):145–9.
Essien EM, Ebhota MI. Platelet hypersensitivity in acute malaria (Plasmodium falciparum) infection in man. Throm Haemost 1981;46(2):547–9.
Horstmann RD, Dietrich M, Bienzle U, Rasche H. Malaria-induced thrombocytopenia. Blut 1981;42(3):157–64.
Dodoo D, Omer FM, Todd J, Akanmori BD, Koram KA, Riley EM. Absolute levels and ratios of proinflammatory and anti-inflammatory cytokine production in vitro predict clinical immunity to Plasmodium falciparum malaria. J Infect Dis 2002;185(7):971–9.
Saravu K, Docherla M, Vasudev A, Shastry BA. Thrombocytopenia in vivax and falciparum malaria: an observational study of 131 patients in Karnataka, India. Ann Trop Med Parasitol 2011;105(8):593–8.
Lacerda MV, Mourao MP, Coelho HC, Santos JB. Thrombocytopenia in malaria: who cares? Mem Inst Oswaldo Cruz. 2011;106 Suppl 1:52–63.