Kini Reshma Gopal, Chandrashekhar Jayaprakash
Assistant Professor, Department of Pathology, Father Muller Medical College Mangalore, Karnataka, India .
Professor, Department of Pathology, Father Muller Medical College Mangalore, Karnataka, India .
J Clin Diagn Res. 2016 May;10(5):EC44-8. doi: 10.7860/JCDR/2016/16425.7887. Epub 2016 May 1.
Haematological changes are the most common complications encountered in malaria. There is significant correlation between several of the haematological parameters and the clinical profile, prognosis and mortality in malaria. White cell counts and differentials are among the most basic and primary investigations done in a patient presenting with fever of short duration.
This study analyzes the numerical and morphological changes in White Blood Cells (WBCs) in peripheral blood in patients with acute malaria in endemic region in an effort to get a picture of specific changes that could be identified by basic investigations.
This study was conducted in tertiary care hospital in a region endemic for malaria. EDTA anticoagulated venous blood samples from 600 patients diagnosed with vivax and falciparum malaria was analysed in Coulter counter LH 500 for the white cell count and differentials. Morphological changes were looked for in Leishman stained peripheral blood smear. Comparison with age matched healthy controls was done by ANOVA with Bonferroni test wherever applicable.
Patients with malaria showed significant leucopenia, neutrophilia, lymphocytopenia, monocytosis and eosinopenia. Lymphocytopenia was more severe in the falciparum group as compared to the vivax group. A higher White Cell Count (WCC) was seen in patients with higher haemoglobin levels in vivax group. The total leukocyte count showed a negative correlation with neutrophil count in falciparum malaria and a strong positive correlation with neutrophil count in vivax malaria. Band neutrophils were seen in 10% of the patients with falciparum and 1.1% of patients with vivax malaria. Atypical plasmacytoid lymphocytes were the only notable morphological finding.
Changes in leukocyte number and morphology in the peripheral blood are common. A combination of monocytosis and eosinopenia in a patient presenting with fever should alert the observer to the presence of malaria and should prompt a repeat blood smear examination in case of initial negative results for the parasite.
血液学变化是疟疾最常见的并发症。疟疾的几个血液学参数与临床特征、预后及死亡率之间存在显著相关性。白细胞计数及分类是对短期发热患者进行的最基本和初步的检查项目之一。
本研究分析流行地区急性疟疾患者外周血白细胞（WBC）的数量和形态变化，以了解通过基本检查可识别的具体变化情况。
本研究在疟疾流行地区的一家三级护理医院进行。对600例诊断为间日疟和恶性疟的患者采集乙二胺四乙酸（EDTA）抗凝的静脉血样本，用库尔特LH 500血细胞分析仪分析白细胞计数及分类。在利什曼染色的外周血涂片上观察形态变化。在适用的情况下，通过方差分析和邦费罗尼检验与年龄匹配的健康对照进行比较。
疟疾患者出现显著的白细胞减少、中性粒细胞增多、淋巴细胞减少、单核细胞增多和嗜酸性粒细胞减少。与间日疟组相比，恶性疟组的淋巴细胞减少更为严重。间日疟组血红蛋白水平较高的患者白细胞计数（WCC）也较高。在恶性疟中，总白细胞计数与中性粒细胞计数呈负相关，而在间日疟中与中性粒细胞计数呈强正相关。10%的恶性疟患者和1.1%的间日疟患者可见杆状核中性粒细胞。非典型浆细胞样淋巴细胞是唯一值得注意的形态学发现。
外周血白细胞数量和形态的变化很常见。发热患者若同时出现单核细胞增多和嗜酸性粒细胞减少，应提醒观察者注意疟疾的存在，若最初寄生虫检查结果为阴性，则应促使再次进行血涂片检查。
