Haematological changes in falciparum malaria and tumor necrosis factor

Tumor necrosis factor and various haematological parameters were studied in 90 patients suffering from falciparum malaria. They were divided into three groups on the basis of haemoglobin level. The difference in haemoglobin level between group-1 (Hb < 7 gm/dl) and group-2 (Hb 7-10 gm/dl), as well as group-1 and group-3 was statistically significant. The geometric mean TNF alpha concentrations in group-1 (193.9 pg/ml) and group-2 (132.2 pg/ml) were higher as compared to group-3; however, the difference was statistically non-significant. The TNF concentration in group-2 correlated negatively with haemoglobin level (r = .43, p = .05). As a whole, 21% patients had leukocytosis, 3% leukopenia, 46% increased ESR and 26% elevated levels of fibrin degradation products. The platelet count was done only in 4 patients with bleeding problems. Twenty-five healthy subjects were included in the study as controls. The difference between TNF and haemoglobin level in group-1 and controls was statistically significant (p < .05, p < .001 each). The role of tumor necrosis factor in the production of these changes is discussed.