SPLENOMEGALY AND THROMBOCYTOPENIA - IN CORRELATION WITH THE TYPE AND SEVERITY IN MALARIA

Malaria is a common communicable disease and is a majorpublic health problem in India, resulting in high morbidity and mortality.Splenomegaly and thrombocytopenia are common findings in malaria.Thrombocytopenia is present in 80% of the patients with malaria and somestudies show that thrombocytopenia in malaria closely correlates with thedegree of parasitemia. However, thrombocytopenia is not included in the WHOcriteria for severe malaria. This study aims to find whether thrombocytopeniacan be an indicator of severe malaria as it is a hematological parameter thatis present even before other features of severe malaria set in. It also aims tofind the association between degree of thrombocytopenia and splenomegaly inmalaria.

Severe malaria is defined accordingto the WHO guidelines. The presence of one or more of the following clinical orlaboratory features classifies the adult patient as suffering from severemalaria. Clinical features like a) impaired consciousness or unrousable coma,b) prostration (generalized weakness so that the patient is unable to walk orsit up without assistance), c) multiple convulsions (>2 episodes in 24hours),d) deep breathing, respiratory distress (acidotic breathing), e) circulatorycollapse or shock (systolic BP <70mmHg), f) clinical jaundice plus evidenceof other vital organ dysfunction, g) hemoglobinuria, h) abnormal spontaneousbleeding, i) pulmonary edema (radiological). Laboratory findings like a)hypoglycemia (blood glucose <40mg/dl), b) metabolic acidosis (plasmabicarbonate <15mmol/l), c) normocytic anemia (Hb <5g/dl, packed cellvolume <15%), d) hemoglobinuria, e) hyperlactataemia (lactate >5mmol/l),f) renal impairment (serum creatinine >3mg/dl), g) hyperparasitemia(2%/100,000/μl in low intensity transmission areas or >5% or 250,000/μl inhigh intensity transmission areas).

Thrombocytopenia by definition isan abnormally low amount of platelets, less than 1,50,000 per microliter ofblood.