Hide and seek: hematological aspects of malaria - a developing country perspective

Malaria, a major problem in tropical climates, presents with various hematological aberrations. We aimed to assess whether complete blood indices would increase the probability of malaria in patients with acute febrile illness.

Between February 2009 and December 2010, we conducted a study involving 824 consenting consecutive patients older than 12 years with a confirmed diagnosis of malaria based on thick and thin blood films. A detailed history and physical examination were completed on all patients before inclusion. Complete blood counts and detection of Plasmodium species were also performed as well as liver function tests, prothrombin time, reticulocyte counts, and parasite load. All data was analysed using SPSS 16.0 and percentages were calculated.

Out of 824 patients, 616 (75%) were male and 208 (25%) were female with an age range of 18 to 55 years (33.2 ± 8.3). Out of 87% thrombocytopenic patients, 66% were affected with Plasmodium falciparum and 21% with Plasmodium vivax. In patients with P. falciparum, thrombocytopenia was mild (16%), moderate (43%) and severe (7%), while in P. vivax patients thrombocytopenia was mild (10%) and moderate (9%). Thrombocytopenia was moderate in the mixed cases (2%). Anemia was seen in 71% and normal leucocyte counts were observed in 79% of the cases. Normal differential leucocytes counts were seen as follows: eosinophils in 80%, neutrophils in 93%, lymphocytes in 85%, monocytes in 97%, and basophils in 100%.

Blood indices should be included in patient evaluations as various hematological aberrances can lead to the diagnosis of malaria.