Thrombocytopenia in patients of malaria.
MATERIALS AND METHODS: This hospital based study was conducted on 180 diagnosed cases of Malaria in the department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India from January 2010 to June 2011. Malaria was diagnosed by examination of thick and thin blood films (smears). Patients with peripheral blood smear positive for malarial parasite were included in the study. Platelet count was obtained by using an automated cell counter. Reduced platelet count (thrombocytopenia) was confirmed by manual method and subdivided as mild thrombocytopenia ([greater than or equal to] 50-149 x [10.sup.3]/[micro]L), moderate (> 20-49 x [10.sup.3]/[micro]L) and severe (< 20 x [10.sup.3]/[micro]L). The study was approved by the ethics committee. Data was entered in excel spreadsheet and statistical analysis was performed. Correlation of mild, moderate and severe thrombocytopenia with different types of malaria, age and sex was done.
RESULTS: A total of 180 patients positive for Malaria were included in the study. 99 patients (55%) were positive for Plasmodium vivax, 74 patients (41%) were positive for Plasmodium falciparum and 7 patients (4%) had mixed infection (Plasmodium vivax and Plasmodium falciparum). Out of the total 180 patients, 153 (85%) patients had thrombocytopenia. Mild thrombocytopenia was seen in 100 patients (55%), Moderate thrombocytopenia in 41 patients (23%) and severe thrombocytopenia in 12 patients (7%) (Table 1). The age group of the patients ranged from 10-84 years. 100 patients (56%) were males and 80 patients (44%) were females.
The platelet counts in the malaria patients ranged from 4-333 x [10.sup.3]/[micro]L. Among the Vivax malaria patients, 62 had mild thrombocytopenia, 8 had moderate thrombocytopenia and 2 had severe thrombocytopenia. Normal platelet counts were seen in 27 patients. Among the falciparum malaria patients, 37 had mild thrombocytopenia, 30 had moderate thrombocytopenia and 7 had severe thrombocytopenia. Among the patients suffering from mixed (Vivax and falciparum malaria) infection, mild thrombocytopenia was seen in 1 patient. Moderate and severe thrombocytopenia was seen in 3 patients each (Table 2). None of the patients suffering from Falciparum and mixed infection had normal platelet counts.
In mild thrombocytopenia, 62% cases were seen in P. Vivax followed by (37%) and (1%) in P. Falciparum and mixed infection (P. falciparum & P. vivax), respectively. The association between mild thrombocytopenia and type of malaria were statistically significant. (Table 3)
Proportion of P. Falciparum malaria was 54.1% among males as compared to 45.9% in females. The association between sex and P. Falciparum malaria was not statistically significant. (Table 4)
Table 5 shows that highest proportion (48.3%) of different types of malaria were in 20-45 years of age followed by 31.7% in more than 45 years of age.
In 10-19 years age group, most common was P.Vivax (52.8%) followed by P. falciparum (36.1%). The association of age (10-19 years) and different types of malaria was statistically significant. (Table 5)
DISCUSSION: Previous studies also show a high incidence of thrombocytopenia in cases of malaria. Colonel et al  reported thrombocytopenia in 72% patients with malaria infection. In Liberia, Mahmood et al studied a total of 145 patients who had P. falciparum malaria. Out of these, 109(75.18%) had thrombocytopenia . Bashwari et al  from Saudi Arabia reported thrombocytopenia in 53% of malaria cases. Shaikh et al  revealed 85.5% patients with malaria having a low platelet count. Zubair et al reported thrombocytopenia in 89% patients with P. vivax. 68.4% had mild thrombocytopenia, 17.5% had moderate thrombocytopenia and 3.5% had severe thrombocytopenia. 10.5% had normal platelet counts . Among the various haematological changes in malaria, thrombocytopenia is the most consistent one, which occurs in more than half of the patients . In our study, thrombocytopenia was found in 85% of malaria patients. The majority of patients had mild to moderate thrombocytopenia.
CONCLUSION: In our study, thrombocytopenia was the haematological parameter studied. Thrombocytopenia is quite frequently associated with malaria and has been reported by many workers .
ACKNOWLEDGEMENT: My sincere thanks to Dr Shriram Gosavi, Assistant Professor, Community Medicine at Dr Vasant Rao Pawar Medical College, Hospital & Research Centre, Nashik, Maharashtra for the statistical analysis.
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(1). Preeti Bajaj
(2). Balbir Singh Shah
(3). Amrit K Dhooria
(4). Manvi Gupta
PARTICULARS OF CONTRIBUTORS:
(1.) Associate Professor, Department of Pathology, Dr. Vasant Rao Pawar Medical College, Hospital & Research Centre, Adgaon, Nashik. Maharashtra.
(2.) Professor & HOD, Department of Pathology, PIMS, Jalandhar.
(3.) Attending Consultant, Department of Pathology, DMCH, Ludhiana, Punjab.
(4.) Senior Resident, Department of Pathology, DMCH, Ludhiana, Punjab.
NAME ADRRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Preeti Bajaj, Associate Professor, Pathology, Dr. Vasantrao Pawar Medical College, Hospital & Research Centre, Adgaon, Nashik, Maharashtra.
Date of Submission: 06/06/2013.
Date of Peer Review: 06/06/2013.
Date of Acceptance: 12/07/2013.
Date of Publishing: 18/07/2013
Table 1: Platelet Counts in Malaria Patients: Platelets No: of patients Normal platelet counts ([greater than or 27 equal to] 150 x [10.sup.3]/[micro]L) Mild thrombocytopenia ([greater than or 100 equal to] 50 - 149 x [10.sup.3]/[micro]L) Moderate thrombocytopenia (> 20 - 49 x 41 [10.sup.3]/[micro]L) Severe thrombocytopenia (< 20 x 12 [10.sup.3]/[micro]L) Table 2: Platelet Counts in patients with different types of Malaria Type of Normal platelet Mild Moderate Malaria count [greater thrombocytopenia thrombocytopenia than or equal [greater than or > 20-49 x to] 150 x equal to] 50-149 [10.sup.3]/ [10.sup.3]/ x [10.sup.3]/ [micro]L [micro]L [micro]L P. vivax 27 62 08 P. falciparum -- 37 30 Mixed -- 01 03 Type of Severe Number of Malaria thrombocytopenia patients < 20 x [10.sup.3]/ [micro]L P. vivax 02 99 P. falciparum 07 74 Mixed 03 07 Table 3: Association of thrombocytopenia with different types of malaria FALCIPARUM VIVAX MIXED Chi-square P value INFECTION MILD 37 (37.0) 62 (62.0) 1 (1.0) 17.6 < 0.001 * MODERATE 30 (73.2) 8 (19.5) 3 (7.3) 52.7 < 0.001 * SEVERE 7 (58.3) 2 (16.7) 3 (25.0) 31.5 < 0.001 * Figures in parenthesis are percentages (* statistical significant) Table 4: Association of sex with different type of malaria FEMALE MALE P value FALCIPARUM 34 (45.9) 40 (54.1) > 0.05 Vivax 44 (44.4) 55 (55.6) > 0.05 Mixed 2 (28.6) 5 (71.4) > 0.05 Table 5: Association of age with different types of malaria Age in years Falciparum Mixed Vivax 10-19 13 (36.1) 4 (11.1) 19 (52.8) 20-45 33 (37.9) 3 (3.4) 51 (58.6) More than 45 28 (49.1) 0.0 29 (50.9) Total 74 (41.1) 7 (3.9) 99 (55.0) Age in years Total Chi-square P value 10-19 36 (20.0) 7.09 0.02 * 20-45 87 (48.3) 13.79 0.001 * More than 45 57 (31.7) 6.72 0.03 * Total 180 (100.0)
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Bajaj, Preeti; Shah, Balbir Singh; Dhooria, Amrit K.; Gupta, Manvi|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Jul 22, 2013|
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