Abstract
Introduction: Falciparum malaria accounts for most of the deaths amongst the malaria cases. Severe falciparum malaria is infact a medical emergency and requires immediate management and intensive nursing care. It is prone to complications such as cerebral malaria, hypoglycaemia, acidosis, renal impairement, liver dysfunction etc. The haematological abnormalities that may be seen in P. falciparum malaria are anemia and thrombocytopenia. Thrombocytopenia could be an early marker of disease severity. The aim of our study was to study the incidence and prognostic value of thrombocytopenia in Plasmodium falciparum malaria.
Material and Method: This was an prospective observational study done on 80 admitted patients of falciparum malaria in Department of Medicine, Rajendra institute of medical science, Ranchi, Jharkhand.
Results: The total no. of case studied were 80(n=80). The mean age of patients were 34.72 ± 12.54 years. Majority of the cases (64) were seen in age group 20 -50 years (80%). On seeing the sex distribution, total no. of cases among male patients were 60(75%) and amongst females were 20(25%), no. of males was more than females. Majority of the cases were from rural areas 57(71.25%) as compared to urban areas 23(28.75%) which may be due to poverty, lack of proper education and living in unhygienic conditions. 31.25% of the patients (25) were tribal and 68.75 % (55) were non-tribals. Mild thrombocytopenia was seen in 16 patients (35.56%) of complicated malaria as compared to 15 patients (42.86%) of uncomplicated malaria. Moderate thrombocytopenia is seen in 22 patients (48.89%) of complicated cases as compared to 08 patients (22.86%) of uncomplicated malaria cases. Severe thrombocytopenia was observed in 06 patients, all patients (13.33%) were having complicated malaria and no patients of uncomplicated malaria had severe thrombocytopenia.
Conclusion: Amongst the various markers of falciparum malaria such as jaundice, anemia, splenomegaly, thrombocytopenia has emerged as the strongest predictor of falciparum malaria. The sensitivity of thrombocytopenia together with acute febrile syndrome was almost 100% for malarial diagnosis. Overall incidence of thrombocytopenia with falciparum malaria was 83.75%. Thromobocytopenia manifests before even anemia and splenomegaly sets in. Thus, it could help in early diagnosis of falciparum malaria so that antimalarial drugs could be initiated in time saving many lives. Thrombocytopenia is a marker of severe disease in falciparum malaria.
Keywords: Severe falciparum malaria, Haematological abnormalities, Thrombocytopenia
References
- World malaria report. Geneva: World Health Organization; 2017.
- Harrison’s Principle of Internal Medicine 19th edition pp1368-1384.
- Mohapatra MK, Sethi G, Das SP, Patnaik Incidence, outcome and predictive factors of falciparum malaria with multiorgan failure. J Assoc Physicians India. 2001;49:149-50.
- Wickramasinghe SN, Abdullah Blood and bone marrow changes in malaria. Ailliere‟s Best Pract Res ClinHematol. 2000;13(2):27.
- Facer CA. Hematological aspects of malaria. In: Infection and Hematology. Oxford: Butterworth Heinemann Ltd.; 1994. p. 259-94.
- Perrin LH, Mackey LJ, Miescher PA. The hematology of malaria in man. Semin Hematol 1982;19:70-82.
- Maina RN, Walsh D, Gaddy C, Hongo G, Waitumbi J, Otieno L, et al.Impact of Plasmodium falciparum infection on haematological parameters in children living in Western Kenya. Malar J 2010;9Suppl 3:S4.
- Chandra S, Chandra H. Role of haematological parameters as an indicator of acute malarial infection in uttarakhand state of India. Mediterr J Hematol Infect Dis 2013;5:e2013009.
- Flemina, Menendez C. Malaria Parasitol Today. 2000; 16:476-496.
- Jamal Khan SS, Khan FR, Usman M, Zahid Malaria can lead to thromboc-ytopenia. Rawal Med J. 2008;33(2):183-5.
- Yamaguchi S, Kubota T, Yamagishi T, Okamoto K, Izumi T, Takada M, et al. Severe thrombocytopenia suggesting immunological mechanisms in two cases of vivax Am J Hematol. 1997 Nov;56(3):183-6.
- Casals-Pascual C, Kai O, Newton CR, Pasha N, Roberts Thrombocytopenia in falciparum malaria is associated with high concentrations of IL-10. Am J Trop Med Hyg. 2006 Sep;75(3):434-6.
- Igbeneghu C, Odaibo AB, Olaleye DO. Impact of asymptomatic malaria on some hematological parameters in the Iwo community in Southwestern Nigeria. Med PrincPract. 2011;20:459–463.
- Kumar A, Shashirekha Thrombocytopenia- an indicator of acute vivax malaria. Indian J PatholMicrobiol. 2006;49:505–508.
- Chandra H, Chandra S, Rawat A, Verma SK. Role of mean platelet volume as discriminating guide for bone marrow disease in patients with thrombocytopenia Int J Lab Hematol. 2010;32:498–505.
- World Health Organisation: Severe falciparum malaria: Communicable Diseases cluster. Trans R Soc Trop Med Hyg 2000, 94 (Suppl) : 51-590.
- Talib VH, Hajira BD, Diwan VM, Verma A clinico-hamatological profile of malaria. J Assoc Physicians India. 1982;30(6):402-4.
- Murthy GL, Sahay RK, Srinivasan VR, Upadhaya AC, Shantaram V, Gayathri Clinical profile of falciparum malaria in a tertiary care hospital. J Indian Med Assoc. 2000 Apr;98(4):160-2.
- Mehta SR, Naidu G, Chandra V, Singh IP, Johri S, Ahuja Falciparum malaria present day problems-an experience with 425 cases. J Assoc Physicians India. 1989;37(4):264-7.
- Jadhav UM, Patkar VS, Kadam Thrombocytopenia in malaria: correlation with type & severity of malaria. J Assoc Physicians India. 2004;52:615-8.
- Kumar A, Sasirekha. Thrombocytopenia: an indicator of acute vivax malaria. Indian J Pathol Microbiol. 2006 Oct;49(4):505-8
Corresponding Author
Manmeet Topno
Junior Resident, Department of Medicine, Rajendra institute of Medical Sciences Ranchi
Add: RIMS Boys Hostel No. 5, Room no. 89, Bariatu, Ranchi R.M.C.H Dist- Ranchi Pin- 834009 Jharkhand, India
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DOI: https://dx.doi.org/10.18535/jmscr/v6i11.12
