EVALUATION OF HEMATOLOGICAL CHANGES AND TYPES OF ANAEMIAS IN MALARIA
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Keywords
Plasmodium vivax, plasmodium falciparum, malarial parasite, hemoglobin
Abstract
Introduction: Malaria continues to pose a significant health challenge in endemic regions, often leading to a range of hematological abnormalities that complicate both diagnosis and clinical management.
Aims & Objectives: To observe, compare, and assess the severity of hematological changes associated with various types of malaria-induced anemias in the adult population.
Methodology: This cross-sectional analytical study was conducted at Rahbar Medical & Dental College Lahore, over a duration of six months (October 2024 till March 2025). Adult patients presenting to the outpatient department with clinical symptoms of malaria specifically fever, chills, and rigors were screened for malaria via peripheral blood smear microscopy. Patients with confirmed malarial parasites were enrolled in the study. Thick and thin blood films were prepared and stained using Leishman’s stain for species identification. Hematological parameters, including complete blood count (CBC), hemoglobin concentration, total leukocyte count, and platelet count, were analyzed using an automated hematology analyzer (Sysmex). Hematological indices were recorded and correlated with the identified Plasmodium species to determine the extent and nature of the abnormalities.
Results & Findings: A total of 165 patients were included, comprising 103 males (62.5%) and 62 females (37.5%), with an age range of 15 to 70 years (mean age: 38 ± 15 years). Plasmodium vivax was detected in 133 patients (81%), whereas Plasmodium falciparum was found in 32 patients (19%). Anemia was present in 126 patients (76.4%), while 39 patients (23.6%) had normal hemoglobin levels. Among anemic patients, 77 (61.1%) exhibited hypochromic microcytic anemia and 49 (38.9%) had normochromic normocytic anemia. With respect to white blood cell counts, 118 patients (71.5%) had normal counts, 28 (17%) had leukocytosis, and 19 (11.5%) exhibited leukopenia. Platelet count analysis revealed that 41 patients (25%) had normal platelet levels, while 65 (39%) had mild thrombocytopenia, 44 (27%) moderate thrombocytopenia, and 15 (9%) severe thrombocytopenia.
Conclusion: Both Plasmodium vivax and Plasmodium falciparum are associated with significant hematological abnormalities, primarily anemia and thrombocytopenia. Plasmodium vivax infection was more prevalent and frequently associated with microcytic hypochromic anemia and lower hemoglobin levels. These findings emphasize the importance of early hematological assessment and species-specific management strategies in malaria-endemic settings.
References
2. Bashawri LA, Mandil AA, Bahnassy AA, Ahmed MA. Malaria: Hematological Aspects. Ann Saudi Med. 2002;22(5-6):372-6. doi: https://doi.org/10.5144/0256-4947.2002.372.
3. Babariya MJ, Parmar JKS. Study of haematological parameters in malaria: a prospective study. Trop J Pathol Microbiol. 2020;6(1):20-25. doi:10.17511/jopm.2020.i01.04.
4. Chandra S, Chandra H. Role of hematological parameters as an indicator of acute malarial infection in Uttarakhand state of India. Mediterr J Hematol Infect Dis. 2013;5(1):e2013009. doi: https://doi.org/10.4084/mjhid.2013.009.
5. Kotepui M, Phunphuech B, Phiwklam N, Uthaisar K. The Hematological Alteration of Patients Parasitized by Plasmodium vivax. Walailak J Sci Technol. 2018;15(9):637-643. doi: https://doi.org/10.48048/wjst.2018.4592.
6. Hyder A, Mahmood A, Mahmood R, Iqbal MI. Evaluation of haematological parameters in malaria infection and its association with different species of malarial parasite. Pak Armed Forces Med J. 2020;70(5):1576-1580.PAFMJ
7. Akhter N, Mazari N, Asif M, Khan AR, Habiba U, Ammar T. Hematological changes in patients with malaria in a tertiary care hospital, Multan, Punjab, Pakistan. Int J Community Med Public Health. 2021;8(12):5890-5894. doi: https://doi.org/10.18203/2394-6040.ijcmph20214609.
8. Haroon A, Zameer H, Naz A, Afzal S, Ammar T, Zafar I. Deranged hematological profile in patients presenting with malarial parasitaemia. Int J Community Med Public Health. 2021;8(12):5900-5904. doi: https://doi.org/10.18203/2394-6040.ijcmph20214450.
9. Shah S, Billah M, Shinwari N, Basharat A, Shah M. Study of Hematological Parameters in Plasmodium Vivax Malaria In Mardan, Khyber Pakhtunkhwa. J Saidu Med Coll Swat. 2019;9(2):107-111. doi: https://doi.org/10.52206/jsmc.2019.9.2.%25p.
10. McMorran BJ, Marshall VM, de Graaf C, et al. Platelets kill intraerythrocytic malarial parasites and mediate survival to infection. Science. 2009;323(5915):797-800. doi: https://doi.org/10.1126/science.1166296.
11. Lacerda MVG, Mourão MPG, Coelho HC, Santos JB. Thrombocytopenia in malaria: who cares? Mem Inst Oswaldo Cruz. 2011;106(1):52-63. https://doi.org/10.1590/S0074-02762011000100008.
12. Kho S, Barber BE, Johar E, et al. Platelets kill circulating parasites of all major Plasmodium species in human malaria. Blood. 2018;132(12):1332-1344. https://doi.org/10.1182/blood-2018-04-844274.
13. Manmeet KG, Manisha M, Sachan B, et al. Thrombocytopenia in malaria and its correlation with different types of malaria. Ann Trop Med Public Health. 2013;6(2):197-200.BioMed Central
14. Kotepui M, Phunphuech B, Phiwklam N, et al. Effect of malarial infection on haematological parameters in population near Thailand–Myanmar border. Malar J. 2014;13:218. doi: https://doi.org/10.1186/1475-2875-13-218.
15. Da Costa Lima-Junior J, Nunes Rodrigues-da-Silva R, Araujo Pereira V, et al. Cells and mediators of inflammation in the acute and convalescent phases of uncomplicated Plasmodium vivax and Plasmodium falciparum infection. Mem Inst Oswaldo Cruz. 2012;107(8):1035-1041. doi: https://doi.org/10.1590/S0074-02762012000800004.
16. Akinosoglou KS, Solomou EE, Gogos CA. Malaria: a haematological disease. Hematology. 2012;17(2):106-114. doi: https://doi.org/10.1179/102453312X13336169155457.
17. Kotepui M, Piwkham D, PhunPhuech B, et al. Effects of malaria parasite density on blood cell parameters. PLoS One. 2015;10(3):e0121057. doi: https://doi.org/10.1371/journal.pone.0121057 .
18. Briggs C, Costa A, Freeman L, et al. Development of an automated malaria discriminant factor using VCS technology. Am J Clin Pathol. 2006;126(5):691-698. doi: https://doi.org/10.1309/2X9Y-0Y0Y-9KXH-7N8T.
19. Singh A, Narang V, Sood N, et al. Malaria diagnosis using automated analysers: a boon for hematopathologists in endemic areas. J Clin Diagn Res. 2015;9(10):EC05-EC08. doi: https://doi.org/10.7860/JCDR/2015/15817.6580.
20. Kotepui M, Uthaisar K, Phunphuech B, Phiwklam N. Profiles of hematological parameters in Plasmodium falciparum and Plasmodium vivax infections. Infect Drug Resist. 2021;14:4051-4061. doi: https://doi.org/10.2147/IDR.S330935.
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Aisha Qaiser
Assistant Professor, Department of Pathology, Rahbar Medical & Dental College, Lahore, Punjab, Pakistan.
Nidda Ayub
Assistant Professor, Department of Pathology, Rahbar Medical & Dental College, Lahore, Punjab, Pakistan.
Qasim Ishtiaq
Medical Specialist, Department of Medicine, NMC ZINDMAAN, Karachi, Pakistan.
Hareem Tariq
Demonstrator Gomal Medical College, Dera Ismail Khan, KPK, Pakistan.
Husna Amanyar
Medical Student, Fatima Jinnah Medical University Lahore, Pakistan.
Rukhsana Gulzar
Assistant Professor, Department of Pathology, Rahbar Medical & Dental College, Lahore, Punjab, Pakistan.
Sehar Gulzar
Sr. Lecturer, Fatima Memorial College of Medicine & Dentistry, Lahore, Pakistan.