Frequency of malaria species in Lahore and its relation with hematological changes

Abstract

Objective: To determine the incidence of malaria species in our area and to evaluate degree of variation of hematological abnormalities. Study Design: Descriptive study Settings: Farooq Hospital west wood branch affiliated with Akhter Saeed Medical and Dental College  Period: August 2015 to July 2017. Material and Methods: Total 320 malaria positive patients fulfilling our inclusion criteria were enrolled in this study. Patients with known thrombocytopenia history, chronic liver disease and dengue co-infection were excluded. Complete blood counts of patient were performed on Sysmex KX-21 analyzer. Thick and thin blood film examinations were performed for malarial parasite confirmation and specie identification. Patients were divided in 5 groups on basis of age including<15, 16-30, 31-45, 46-60 and >61 years. Thrombocytopenia was categorized as mild, moderate and severe if platelets count was 51-150 x 109/l, 20-50 x 109/l and <20 x 109/l respectively. Anemia was categorized as mild, moderate and severe if Hemoglobin level was above 10 g/dl but below normal level, 8.0-10 g/dl and <8.0 g/dl respectively. Data was analyzed using SPSS version 24.0. Results: Out of 320 enrolled malaria positive patients, 278 (86.9%) were infected with Plasmodium vivax and 42 (13.1%) were positive for Plasmodium falciparum. Overall 258 (80.6%) patients presented thrombocytopenia, 55 (17.2%) patients presented leukopenia and 190 (59.4%) patients presented anemia. Anemia was more frequently observed in two age groups including <15years and 16-30 years whereas <15 years age group presented significantly high incidence of microcytic hypochromic anemia (p-value 0.000). Significant variations in results of hematological findings were observed in patients infected with different malarial species. Finding of anemia was more common in P. falciparum malaria whereas frequency of severe and moderate thrombocytopenia was also significantly highin Falciparum infected patients (p-value 0.000). Statistically significant variation in relative and absolute neutrophils and lymphocytes count was observed. Conclusion: In our setup P. vivax infection is more prevalent than P. falciparum. Malaria causes significant variation in hematological findings. Thrombocytopenia is commonly observed especially in patients infected with P. falciparum. Addition of absolute differential leukocyte counts in reporting of complete blood counts can improve sensitivity of results and improvement in diagnosis.