Overt bleeding in complicated P. falciparum malaria: An experience from east coast of India

Delay in diagnosis of falciparum may result in complicated, life-threatening conditions. Though haematological abnormalities and coagulopathy are common complications that occur in malaria but complications with rare manifestations like overt bleeding do pose challenges for the clinicians worldwide. This study reports the incidence and prognosis of overt bleeding from the east coast of India and makes an attempt to relate it with the pathogenesis of the disease in severe Plasmodium falciparum malaria patients. This study was conducted in Sriram Chandra Bhanj Medical College Hospital, Cuttack, Odisha, India. A total of 120 complicated (multi organ dysfunction) malaria cases were included in this study. Amongst them 54 (45.0%) showed signs of overt bleeding and clinically the bleeding was either from one or multiple sites. Out of the total overt bleeding cases, 79.6% had elongated prothrombin time (PT), activated partial prothrombin time (aPTT) and elevated D-dimer with thrombocytopenia indicating disseminated intravascular coagulopathy (DIC). It was observed that case fatality rate was very high in coagulopathy group than the non coagulopathy group. Our observations highlight that awareness of overt bleeding in P. falcipatum infection is necessary for general practitioners in endemic areas for malaria like in Odisha for effective and timely management of complicated patients.Timely diagnosis and treatment of DIC with appropriate prescribed drugs can prevent and cure the complications of severe falciparum malaria with anti-malarial treatment.