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Thrombocytopenia in patients of malaria.

INTRODUCTION: Malaria remains today one of the major health problems in most parts of India with increased morbidity and mortality [1]. Malaria is caused by protozoa parasite of the genus Plasmodium which infects and destroys red blood cells. Four species of Plasmodia [Plasmodium falciparum (P. falciparum), Plasmodium malariae, Plasmodium ovale and Plasmodium vivax (P. vivax) cause malaria in humans of which P. falciparum is the most common cause of morbidity and mortality [2]. Haematological abnormalities have been observed in patients with malaria, anaemia and thrombocytopenia being the most common [3].

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 [40] 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 [5]. Bashwari et al [6] from Saudi Arabia reported thrombocytopenia in 53% of malaria cases. Shaikh et al [7] 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 [8]. Among the various haematological changes in malaria, thrombocytopenia is the most consistent one, which occurs in more than half of the patients [9]. 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 [10].

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.

REFERENCES:

[1.] Makkar, RPS, Mukhopadhyay S, Monga A, Gupta AK. Plasmodium vivax Malaria presenting with severe thrombocytopenia. The Brazilian Journal of Infectious Diseases 2002; 6(5): 263-265.

[2.] Guruprasada Shetty, K Shreedhara Avabratha, Seema Gonsalves, Aby Dany, B Sanjeev Rai. Thrombocytopenia in children with malaria--A study from coastal Karnataka, India. Asian Pacific Journal of Tropical Disease (2012); 107-109.

[3.] Richards, M.W., R.H. Behrens and J.F. Doherty, 1998. Short report: haematological changes in acute, imported Plasmodium falciparum malaria. Am. J. Trop Med. Hyg; 59:859.

[4.] Colonel KMU, Bhika RD, Khalid S, Khaliqe-ur-Rehman S, Syes ZAS. Severe thrombocytopenia and prolonged bleeding time in patients with malaria (a clinical study of 162 malaria cases). World Appl. Sci J 2010; 9(5): 484-488.

[5.] Mahmood A, Yasir M. Thrombocytopenia: A predictor of Malaria among febrile patients in Liberia. Infect Dis. J 2005; 14: 41-4.

[6.] Bashwari, L.A., A.M. Mandil, A.A. Bahnassy, M.A. AI-Shamsi and H.A. Bukhari, 2001. Epidemiological profile of malaria in a University hospital in the eastern region of Saudi Arabia. Saudi Med J; 22(2): 133-8.

[7.] Shaikh MA, Shakeel Ahmed, Inayat Diju, Dur-E-Yakta. Platelet Count in Malaria patients. J. Ayub Med Coll Abbottabad 2011; 23(1): 143-5.

[8.] Zubair W, Muhammad T, Faisal H, Muhammad A, Ghulam R, Abdullah D. Thrombocytopenia and Benign Tertian Malaria. Infect Dis J 2010; 19:192-5.

[9.] Aduragbenro D. Adedapo et al. Age as a risk factor for thrombocytopenia and anaemia in children treated for acute uncomplicated falciparum malaria. J Vector Borne Dis 44, December 2007, pp.266-271.

[10.] Patel U, Gandhi G, Friedman S, Niranjan S. Thrombocytopenia in malaria. J. Natl. Med. Assoc 2004; 96:1212-4.

AUTHORS:

(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.

Email--dr.prbajaj@gmail.com

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
Article Type:Report
Geographic Code:9INDI
Date:Jul 22, 2013
Words:1535
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