The Utility of a Three Part Differential Hematology Analyzer with CRP for Assessing Malaria

Abstract

BackgroundHematology analyzers display abnormal hematology parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining CRP with hematology parameters to obtain further information about the malaria infection.MethodsThe present study shows the results of a retrospective study involving comparison of raw instrument data from a three part differential hematology analyzer with CRP measurement and corresponding microscopic findings of samples obtained during the monsoon season of years 2018 and 2019 in Mumbai, India. Mann-Whitney U and Krustal-Wallis tests were applied for obtaining statistical significance of hematology parameters and CRP among P. vivax, P. falciparum, dengue and negative samples. ResultsThe study considers 1008 non-malaria febrile cases, 209 P. vivax, 31 P. falciparum positive malaria samples, five cases of mixed species malaria infection, and three co-infection of malaria and dengue. Median values of WBCs, PLTs, PCT and %LYM were lower in malaria and dengue samples compared to negative ones with statistical difference (p < 0.05). Contrary, medians of MCHC, MPV, PDW, and %MON were higher than negative samples. The greatest difference in the analyzer results of malaria and dengue cases was observed in between their medians of CRP levels, which is evidenced by the values of the first quartiles of P. vivax and P. falciparum cases, and the third quartile of dengue cases being 8.6 and 10.4 mg/L, respectively.The parameters with a statistical difference for different levels of parasitemia were WBC, PLT, %MON and CRP. An interfering abnormal peak was observed in the white blood cell histogram, below 37 fl, in malaria infected samples, especially in P. vivax cases, where the height of that peak showed a strong correlation with red blood cells infected predominantly with larger parasitic forms.ConclusionsA three differential part hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered.

Discriminant value of automated leucocyte VCS parameters in the detection of tropical infections

“…21 Nishimura et al documented lower TLC and platelet count in malaria and dengue patients with higher MPV, PDW and MCHC. 22 Viswanathan et al has recorded the role of platelet indices in combination with CBC and clinical symptoms can aid in the diagnosis and treatment of tropical acute febrile illnesses. 23 Anabire et al did not find any specific changes in the haematological indices in patients with typhoid fever as compared to malaria patients.…”

“…Motchan et al conducted a 6‐year retrospective analysis of malaria cases and found malaria‐positive cases presents with reduced levels of Hb, RBC count, HCT, TLC, platelet count and PCT whereas RDW, MPV and PDW were elevated significantly paralleled to comparative group 21 . Nishimura et al documented lower TLC and platelet count in malaria and dengue patients with higher MPV, PDW and MCHC 22 . Viswanathan et al has recorded the role of platelet indices in combination with CBC and clinical symptoms can aid in the diagnosis and treatment of tropical acute febrile illnesses 23 .…”