Refractory Anemia and Pancytopenia as Presentations of Falciparum Malaria in Population of Khyber Pakhtunkhwa, Pakistan

Abstract

Background: Falciparum malaria is a common disease in our area. Apart from its classical presentation, at times it may present with refractory anemia or pancytopenia. The aim of this study was to determine the refractory anemia and pancytopenia as complications of falciparum malaria and apart from peripheral blood smears the significance of rapid antigen tests and bone marrow examination in the diagnosis of falciparum malaria. Material & Methods: The descriptive study included 200 consecutive cases of fever and refractory anemia or pancytopenia from 2011 to 2014. Stratification of patients according to the clinical scenario included Group-A having fever with refractory anemia and Group-B with fever and pancytopenia. A detailed history, thorough clinical examination, and pertinent laboratory tests were performed. All patients were treated with antimalarial drugs and followed-up for eight weeks. The pre and post treatment hematologic parameters were compared. Results: Among the 200 patients, 85 were males and 115 females. The age ranged from 15 to 55 years. Stratification of patients on clinical scenario revealed 175(87.5%) patients with fever and refractory anemia (Group-A). Among these, 125(62.5%) patients were reported smear positive for P. falciparum. In the remaining 50 smear negative patients rapid antigen tests were performed and all were reported positive. In 25 patients of Group B with fever and pancytopenia, the peripheral smear for malaria was positive only in 5 patients. In the remaining 20 cases both the peripheral blood smears and rapid antigen tests were reported negative. Bone marrow examination was planned to confirm the bone marrow suppression as the cause of peripheral pancytopenia, to exclude leukemia and to identify P. falciparum. The bone marrow examination revealed P. falciparum in all these cases. All the patients had a dramatic response to treatment with antimalarials in terms of disappearance of fever and correction of anemia and bone marrow rescue with reversal of pancytopenia to normal counts. Conclusion: Plasmodium falciparum should be considered in all cases of prolonged fever with refractory anemia or pancytopenia in malaria endemic areas, even with negative smear and rapid antigen tests. Bone examination is mandatory for the diagnosis in such cases. There is dramatic response of such patients to treatment with antimalarial drugs and hematinics.

Frequency and Etiology of Pancytopenia in Patients Admitted to a Tertiary Care Hospital in Karachi

“…Furthermore, we observed that pancytopenic patients were younger, with a median age of 38.8 years, which is consistent with Samreen et al [14], Tariq et al [15], and Hayat et al [16].…”

“…Hypersplenism accounted for 16.7% of cases of pancytopenia in this study while Hayat et al [16], Osama et al [13], and Ikram et al [6] observed this to be 15.3%,19%, and 25%, respectively. In our study, three out of four patients had hypersplenism because of liver cirrhosis, one had isolated splenomegaly with no cause identified, and only one had cirrhosis secondary to chronic hepatitis C infection.…”

“…Chronic Hodgkin lymphoma was diagnosed in one patient (4.1%); other studies observed malignant conditions more frequently than this [2,9,[13][14][16][17].…”

First report on the Sero-molecular prevalence of Brucella melitensis in local small ruminants in Khyber Pakhtunkhwa, Pakistan

“…In Pakistan, few studies have been conducted on brucellosis in small ruminants despite its zoonotic importance and heavy economic losses. Seroprevalence reported in different areas of Pakistan was reported as 4.4% [11], and 18.75% by [12,13] but to our knowledge, there is no availability of data regarding brucellosis in small ruminants in the study area speci cally. Therefore, the present study is considered the rst step to achieving data regarding brucellosis in small ruminants in the study area.…”

Recent Advancement of the Current Aspects of g‐C3N4for its Photocatalytic Applications in Sustainable Energy System

“…All these drawbacks are associated with low photocatalytic efficiency of PCN. Numerous techniques have been purchased including morphological pore engineering, [92] introducing metal dopants, [93,94] non‐metal dopants, [95] . In the previous five years, there have been several good reviews on the preparation and photocatalytic properties of g‐C 3 N 4 , which are in high demand in scientific research [44–47,96–98] .…”