Observation on relationship of hepatic and renal dysfunction with haemorrheological parameters in plasmodium falciparum malaria in Kosi region, Bihar, India

Abstract

Background: Malaria contribute to be one of the major public health problem in around 1.5 million contribute per year, of which about 52% due to Plasmodium falciparum. The study was designed to assess hepatic and renal dysfunction in plasmodium falciparum malaria, and evaluate if such abnormalities had any bearing with the haemorrheological dysfunction. Methods: Group A comprising 30 cases of plasmodium falciparum positive cases with jaundice or renal failure or both and Group B Comprising 30 cases of falciparum malaria and have no complication. Laboratory investigation was done for liver and renal function test, complete blood count and coagulation profile. The data collected was analysed to inter-correlate parameters of hepatic, renal and haemorrheological dysfunction. Results: Fever was the predominant feature in our study, present in 100% patient followed by chill and rigors which was present in 90% cases of both groups. Hepatomegaly was present in 53.33% cases in group A and 16.67% in group B, whereas spleenomegaly was present in 43.33% cases in group A and 26.67% in group B. Most common complication in group A was jaundice present in 100% cases followed by renal failure present in 53.33% cases. Overt bleeding was present in only 3.33% cases with complicated falciparum malaria. Anemia was present in 73.33% cases of group A and 50% cases in group B. Thrombocytopenia was present in 50% patient in group A and 23.33% in group B. Bleeding time, clotting time, PT with INR, APTT, FDP and LDH was much higher in group A than group B in our study. The biochemical parameters (serum urea, creatinine, bilirubin, AST, ALT, ALP) in both groups differed significantly. In group A Haemoglobin and platelet count significantly negatively correlated with hepatic and renal parameters where as FDP and LDH significantly positively correlated with all the hepatic and renal parameters. In group B the correlation between hematological and biochemical (hepatic and renal) parameters was not found to be statistically significant. Conclusions: Patients of complicated falciparum malaria have significant subclinical haemorrheological disorders even if they do not manifest as clinically overt DIC.