Study of Platelet Count in Malaria Patients and the Correlation Between the Presence and Severity of Platelet Count With Type of Malaria

Abstract

BACKGROUND: Malaria remains one of the major health problems in the tropics with increased morbidity & mortality. Thrombocytopenia is a common finding in malaria, but its correlation with the type of malaria and prognostic implications in context with severity of low platelet count has not been evaluated in large studies. In view of paucity of data from Indian studies, we attempt to correlate the low platelet count with type of malaria and outcome. AIM: Study of platelet count in malaria patients and correlation between the presence and severity of platelet count with type of malaria. MATERIAL & METHODS: A total of 180 patients diagnosed to have Malaria over a period of two years admitted in Guntur Teaching and General Hospital attached to Guntur Medical College, Guntur were studied. All study subjects were identified positive for Malaria parasite on peripheral smear examination with conventional microscopy. Platelet count was done on a fully automated, quantitative analyzer. Daily platelet count was done for all those admitted with malaria. P.falciparum antigen test (PfHrp antigen test-Parascreen) was performed in subjects with P.vivax Malaria on the peripheral smear with a platelet count less than 20,000cells/cmm for more emphatic exclusion of associated P.falciparum infestation. P.falciparum antigen test was also performed in subjects with high index of clinical suspicion or multi organ involvement. RESULTS: a total of 180 patients were found to have malaria, 114(63.3%) were P.vivax, 62(34.4%) were P.falciparum and 4(2.7%) were mixed. 146(81.1%) patients had thrombocytopenia. 34(23.3%) developed complicated malaria. Severe thrombocytopenia was noted in 58.8% of complicated malaria with p<0.001. 20 patients persisted to have thrombocytopenia on 6th day even after adequate therapy. 14(70%) patients out of 20 recovered and 6(30%) died in which 2 was P.falciparum and 4 were mixed infection. CONCLUSION: Thrombocytopenia is a common association of malaria with incidence of 81.1%. Severe thrombocytopenia is commonly seen in P.falciparum. Platelet count <20,000 was seen in P. falciparum and P.vivax. But more commonly in P. falciparum. Out of 36 severe thrombocytopenia 34 developed complicated malaria with significant p value indicating that patients with severe thrombocytopenia at the time of admission are 8.5 times more prone to develop complications when compared to mild and moderate thrombocytopenia. Patients who persisted to have thrombocytopenia even after 6th day of therapy, their mortality increased by 30%.

A study of clinical profile and complication of malaria in a tertiary care centre in South-eastern region of Rajasthan, India

“…23 Present study's results are nearly similar to study done by Gopinath VP et al reported fever in 97.8% and vomiting in 42.2%, headache in 69%, altered sensorium in 8.8% cases, Murthy GL et al who also reported fever with chills and rigor in 98.10%, altered sensorium in 48.10%, headache in 33.40%, diarrhoea in 18.35%, jaundice in 27.21% and oliguria in 6.96% cases, later Madhu Muddaiah et al noticed that fever was present in all cases (100%), nausea and vomiting in 37.36%, headache in 33.6%, jaundice in 15.78%, altered level of consciousness in 4.21% cases, and even Sudheer Babu Devineni et al also noted that fever was the most common symptom (100%) followed by vomiting in 22.22%, headache in 25.56%, jaundice in 15.56%, altered sensorium in 8.89%, pain abdomen in 7.77%, cough and breathlessness in 4.44%, and joint pain in 5.56%. 22,23,29,30 So according to above mentioned studies and the present study commonest symptoms were fever, headache, vomiting and jaundice.…”

“…21,23 Present study was nearly similar to study done by DebT et al who reportedpallor in 65.6% cases, icterus in 5.7% cases, splenomegaly in 45.7%, hepatosplenomegaly in 25.6% cases, Madhu Muddaiah et al reported nearly similar results fever in 98%, pallor in 56%, icterus in 14.73%, hepatosplenomegaly in 13.6%, hepatomegaly in 4.2%, altered level of consciousness in 4.2%, raised bilirubin in 14.73% cases, Shahnaz Shahr, et al reported pallor in 67.7%, splenomegaly in 70.9% cases, Preetam N Wasnik et al in also noticed that 65% subject had pallor, 35% had icterus, 30% had splenomegaly, 22.5%had hepato-splenomegaly and Sudheer Babu Devineni et al also reported that common clinical signs were splenomegaly (86%), pallor (46.6%), icterus (13.3%), hepatomegaly (10%), altered sensorium (8%), petechiae (6%). 22,25,32 According to above mentioned studies and the present study splenomegaly was the most common sign followed by pallor and icterus. A clinical spectrum of fever, splenomegaly and pallor is most often associated with malaria.…”

“…Present study was also supported by Murthy GL et al, Mohapatra et al, Kocher et al, they all observed that P. Falciparum infection was to be predominantly associated with complicated malaria. 19,22,30,32,36 Present and other studies showed that uncomplicated malaria cases were more associated with P.Vivax infection whereas complicated malaria was more associated with P. Falciparum infection. In present study statistically significant association was found between species of malaria parasite and severity of malaria.…”

“…In present study and other similar study, there was mostly young and middle aged group patients were affected. [21][22][23][24] This may be due to young and middle aged group are being more active outdoors from dawn to dusk.…”

Assessment of Complete Blood Count and D-dimer among Patients with Plasmodium falciparum Malaria

“…D-dimer levels offer certain advantages over other thrombin generation assays since them are resistant to ex vivo activation, are relatively constant, and have a long half-life [12]. Elevated serum D-dimer levels may indicate endothelial activation, which in malaria could be related to parasite density and illness intensity [13]. The goal of this study was to evaluate the effect of P.falciprum malria on total blood count and D-dimer levels in plasma of infected patients in Khartoum State, Sudan.…”