Thrombocytopenia and Altered Platelet indices as potential Marker in complicated malaria caused by Plasmodium vivax: cross sectional descriptive study

Abstract

Background: Malaria is a major health problem with increased morbidity and mortality. Plasmodium falciparum and Plasmodium vivax are endemic infections in India and constitutes about 77% of the total malaria cases in Southeast Asia, commonly associated with hematological abnormalities. Hematological abnormalities that are observed in patients with malaria includes anemia and thrombocytopenia. Thrombocytopenia frequently complicates malarial infections and is usually noted in Plasmodium falciparum. In the present study we have tried to evaluate prognostic implications of altered platelet indices and factors associated with outcome of severe and complicated P. vivax malaria.Methods: This is cross sectional descriptive study of 60 patients with malaria caused by P. vivax who presented to Mahatma Gandhi medical college and research institute between june 2014 to April 2016.The smears positive for malaria exclusively caused by P.vivax infection were included in this study. Malaria was diagnosed by microscopic examination with both leishmain stained thin and giemsa stained thick smears. All blood cell counts were determined using automated equipment (ABX Pentra ES 60; Horiba) which provides MPV, PDW and PCT. Result:Out of 60 patients in the present study 56.7% were males and 43.3% were females, age of the patient ranges from 17-48 years with mean (SD) age of distribution were 32.10 (9.52).Complete blood count evaluation of all patients showed mean hemoglobin level of 9 g/dL. Mean hematocrit level of 26.68% (4.2%) and mean leukocyte count of 5866 (1170) cells/mm3. The mean platelet count was 95,247cells/ mm3. The MPV was 9.6 (0.96) µm, Mean PDW was 13.75% (0.89%) and mean PCT was 0.180% (0.033%) Conclusion: Our study concludes that history of fever associated with chills and rigor are sensitive indicator of malaria but lacks specificity. Platelet indices were altered during severe symptomatic malarial infection such as elevation of MPV and PDW with decreased PCT are the known potential risk factors associated with warning signs of acute malaria caused by plasmodium vivax. Even though these hematological parameters are useful predictors of acute malarial infection, identification of parasites and grading of parasitemia in peripheral smear were always gold standard for early treatment.

Role of Platelet Indices as a Potential Marker for Malaria Severity

“…The result for plateletcrit with respect to disease severity was indicated by the median plateletcrit, which is 0.023% for a complicated case as compared to 0.06% in an uncomplicated cohort. A plateletcrit of 0.05% had a sensitivity of 65.6% and a specificity of 70.6% to discriminate severe malaria [ 53 , 54 ]. For the first diagnosis of malaria infection, both platelet count and PCT were the best risk markers with 99% sensitivity and 95% specificity, respectively ( Table 1 ).…”