ABSTRACT
Introduction: Vivax Malarial infection. Dengue Viral fever is also emerging as a Febrile conditions to have reduced platelet count. The absence of the normal platelet count on peripheral smear in case of fever is a clue to the presence of Malaria and Dengue fever. Material & Method: Present study we have tried to study the pattern of thrombocytopenia in these febrile conditions and their diagnostic and prognostic implications. The study was conducted at GMERs Medical College, Gandhinagar. This study group consisted of 146 Patients of Fever treated at Pediatric Department, Malaria diagnosed by thick & thin smear examination. The platelet count was done by Abascus Junior B- Blood Cell counter. Dengue Fever was diagnosed by NS1 Antigen Test. The Mean Platelet counts in P. Falciparum are 69852 cells/mm3, P.Vivax 1,15,580 and Dengue Fever 53,100. Statistically the difference between P. Falciparum & Vivax is significant for differentiating Malarial type. Result: Platelet count <20,0000 cells/mm3 was observed in both the types of Malaria and not seen with Dengue Fever. Profound thrombocytopenia still remains the distinguishing, feature of P. Falciparum Malaria. Platelet count more than 1,00,000 cells/mm3 favours the diagnosis of P.Vivax & Moderate reduction in Platelet Count (between 20,000 to 1,00,00) is clue to P. Falciparum and Dengue Fever. In this segment other diagnostic criteria like pFHrp Antigen and N.S.Antigen should be applied to differentiate these two grave conditions. Thrombocytopenia (Platelet count <150000 cells/mm3) can be considered as a predictor of Malaria and in combination with Anemia (Hb<10gm/dl) is a next best parameter. Unlike Malaria, in Dengue fever thrombocytopenia is usually associated with normal Hemoglobin.
ABSTRACT
Backgroud: Plasmodium Falciparum and P. Vivax are endemic infections in India and commonly associated with Hematological Abnormalities. Severe thrombocytopenia is frequently noticed with P. Falciparum Malaria, but its occurrence is less reported and studied with P. Vivax Malaria. In present study we have tried to evaluate severity & prognostic implications of thrombocytopenia in cases of P Vivax Malaria. The study was conducted in Department of Pediatrics, GMERS Medical College, Gandhinagar.Method: The study group consisted of 92 Pediatric Patients diagnosed on thick & thin blood smear examination having thrombocytopenia. The platelet counts were done by Abacus Junior B Blood Cell Counter. Result: Platelet Count <150000 Cell/mm3 (thrombocytopenia) was observed in 73.92% patients of P. Vivax Malaria. The mean platelet count 1,16,520 is significantly low and the range being 18000 cell/mm3 to 5,10,000 cells/mm3. Anaemia with mean Hemolobin level 8.8 gm/dl. was reported in the patients with P. Vivax Malaria with thrombocytopenia. Discusssion: In our view, this statistically low platelet count in P.Vivax Malaria is having significance & should be kept as differential diagnosis in Acute Febrile conditions. Unnecessary Platelet transfusions can be prevented as noticed in the study. Platelet transfusion was not required in the patients having severe thrombocytopenia (platelet count <20000 cells/mm3)as bleeding tendencies and systemic complications were not observed as compared to Falciparum Malaria. Platelet count and clinical recovery were immediate on 2nd day after initiation of treatment and complete recovery within 7 day without any complications and mortality suggest a good prognosis. Conclusion: Anaemia with severe thrombocytopenia in P. Vivax Malaria required further study to differentiate other febrile conditions with low platelet count and unaltered hemoglobin levels.