VIVAX MALARIA;

Background: The primary health care physician is usually perplexed withregards to selection of initial therapy for patients presenting with fever. Some degrees ofhematological changes do exist in most patients with malaria. How often these changes doexist with malaria in our set up? And whether these changes are due to associated fever oractually resulting because of malaria. Objective: 1-To measure the frequency of abnormalhematological changes in malaria patients in our set up. 2-To compare the hematologicalparameters among subjects with laboratory proven malaria, fever but no malaria diagnosisand healthy controls. Design: Cross-sectional analysis. Place and duration of study: Thisstudy was carried out from May 2010 to Dec- 2010 at department of medicine PNS SHIFA, anddepartments of pathology PNS SHIFA and RAHAT, Karachi. Subjects and methods: Subjectswith history of fever and a clinical suspicion of malaria were recruited from primary physician’sOPD along with healthy age and sex-matched control. First, the frequencies of various abnormalfindings in hematological parameters were measured in subjects diagnosed to have malaria.Later, group-1: [Malaria (Laboratory positive) (n=74)], Group-2: [Fever (Laboratory negative)(n=104)] and group-3: [Age and sex matched controls (n=54)] were evaluated by one wayANOVA followed by post-hoc comparisons for significant differences among groups. Bloodcomplete picture were measured by automated hematology analyzer (Specifications: CELTAC- alpha, MEK-6410 K). Malaria parasite presence was confirmed by both slide examinationtechnique and immune-chromatographic (ICT) testing. Main outcome measures-Hemoglobin,white blood cells (WBC), platelets, PDW, % neutrophil. Results- 21.62 % cases from malariahad anemia, while the occurrence of leucopenia was 62.16%. This leukpenia was associatedwith relative neutrophil excess (63.51%). Thrombocytopenia was the most consistent findingamong our studied subjects (97.30%). The difference between the three groups were significantfor platelets [Group-1, Malaria (Laboratory positive) group= 86.42 (95%CI: 78.43-94.41)][Group 2, Fever (Laboratory negative) group = 192.47 (95%CI: 177.69-207.25)] and (Group-3,Age and sex matched control group=278.89 (95%CI: 254.16-303.62)] {p<0.001}, and WBC[Group-1, Malaria (Laboratory positive) group= 5.55 (95%CI: 5.08-6.01)] [Group 2, Fever(Laboratory negative) group = 6.68 (95%CI: 6.14-7.20)] and (Group-3, Age and sex matchedcontrol group=8.78 (95%CI: 8.01-9.55)] {p<0.001}. The results for % neutrophil and PDW werealso significant, but post-hoc comparison did not show significant differences between groupsthus differentiating a case of malaria from non-malaria fever or control. Conclusion: Malariadue to Plasmodium vivax is associated with thrombocytopenia and leucopenia in our set up.Moreover, the associated hematological parameters including % neutrophil and PDW may helpin augmenting a clinical diagnosis of malaria.