Received Date: October 01, 2017; Accepted Date: October 27, 2017; Published Date: November 06, 2017
Citation: Obeagu EI, Didia BC, Obeagu GU, Azuonwu O (2017) Evaluation of Changes in Haematological Profile of Cerebral Malaria Patients in Enugu State, Southeast, Nigeria. Ann Clin Lab Res Vol.5: No.4:202. DOI: 10.21767/2386-5180.1000202
Cerebral malaria is one of the major complications of Plasmodium falciparum infection. Plasmodium malaria infection is endemic in this part of the world. The study was done to evaluate the changes in haematological profile of cerebral malaria (CM) patients attending a secondary hospital in Enugu State, Southeast, Nigeria. A total of 70 subjects were recruited for the study, 20 were cerebral malaria subjects aged 1-5 years and 50 were control subjects aged matched. The haematological profile was determined using Mindray BC-5300. The results showed significant difference (P<0.05) in WBC, RBC, Hb, MCV, MCH, MCHC and Platelets of the cerebral malaria subjects compared to the control and no significant difference (P>0.05) in absolute neutrophil, absolute lymphocyte, absolute monocyte, absolute eosinophil, and absolute basophil. The effect of cerebral malaria was seen in the red cell line and WBC. This could lead to anaemia and increased chances of low immunity to infections. The red cell line of cerebral malaria patients should be monitored to avoid anemia with its increased chances of high mortality and morbidity. The patients should be properly feed.
Haematological profile; Cerebral malaria patients; Enugu state
Malaria parasitaemia is one of the most important causes of child mortality worldwide, the most frequently encountered in Nigeria and other parts of the world is Plasmodium falciparum which annually kills not less than 1 Million children in Africa alone [1,2]. This death toll is only one aspect of the global burden of malaria. P. falciparium is estimated to cause about half a billion episode of disease each year  and there are hundreds of millions of course due to other parasite species- Plasmodium vivax, Plasmodium malaria, and Plasmodium ovale . Malaria is one of the most important vector born disease, leading to significant morbidity and mortality, transmission of which occurs in all six WHO regions. Globally, an estimated 3.3 billion people are at risk of being infected with malaria and developing disease, and 1.2 billion are at high risk. High risk population is those living in sub Saharan Africa and South-East Asia [4,5]. Approximately 24 million malaria cases and 41000 deaths were reported in 2013 from South Asia, of which 29% deaths were in age group of <5 years of age. It is responsible for major morbidity and mortality in rural paediatric population with varying degrees of presentation. Cerebral malaria (CM) is the most dreaded and not uncommon complication of falciparum malaria and occurs in children under five years of age . Infection with this parasite can be lethal in the absence of prompt recognition of the disease and its complications and urgent appropriate patient management .
The study was done in Niger Foundation Hospital, Independence Layout, Enugu, Nigeria.
The study is a hospital based case study using purposive sampling technique.
The subjects comprised of a total of seventy (70) subjects, 20 subjects were patients aged 1-5 years diagnosed with cerebral malaria and 50 subjects were apparently healthy individuals aged matched as the control.
Informed consents were obtained before sample collection and the confidentiality of the results ensured.
The results were presented in tables as mean and standard deviation and student t-test used for analysis and the level of significance was set at P<0.05.
The haematological investigations were done using Mindray BC-5300.
The results showed significant increase (P<0.05) in WBC and platelets of the cerebral malaria subjects (7.11 ± 2.30 × 109/L, 341.00 ± 26.29 × 109/L) compared to the control (5.20 ± 1.56 × 109/L, 310.00 ± 15.06 × 109/L, significant decrease in RBC, Haemoglobin, PCV, PCV, MCV, MCH and MCHC of the cerebral malaria subjects (4.16 ± 0.82 × 1012/L, 12.90 ± 1.30 g/dL, 38.70 ± 3.82%,87.40 ± 8.34 fl, 31.00 ± 2.86 pg, 355.00 ± 20.02 g/L) compared to the control (4.62 ± 0.54 × 1012/L, 14.70 ± 1.76 g/dl, 44.10 ± 6.36%, 92.00 ± 10.21 fl, 33.40 v1.34 pg, 358.02 ± 17.6 g/L) and no significant difference in absolute neutrophils, absolute lymphocyte, absolute monocyte, absolute eosinphils, absolute basophils of the cerebral malaria subjects (0.75 ± 0.12 × 109/L, 0.18 ± 0.10 × 109/L, 0.05 ± 0.01 × 109/L, 0.01 ± 0.01 × 109/L, 0.01 ± 0.01 × 109/L) compared to the control (0.62 ± 0.16 × 109/L, 0.25 ± 0.12 × 109/L, 0.02 ± 0.01 × 109/L, 0.01 ± 0.01 × 109/L, 0.01 ± 0.01 × 109/L) respectively (Table 1) (Figures 1-6).
|Parameters||CM(20)||Control(50)||Level of significance|
|WBC (× 109/L)||7.11 ± 2.30||5.20 ± 1.56||P<0.05|
|Absolute neutrophil (× 109/L)||0.75 ± 0.12||0.62 ± 0.16||P>0.05|
|Absolute lymphocyte (× 109/L)||0.18 ± 0.10||0.25 ± 0.12||P>0.05|
|Absolute monocyte (× 109/L)||0.05 ± 0.01||0.02 ± 0.01||P>0.05|
|Absolute eosinophil||0.01 ± 0.01||0.01 ± 0.01||P>0.05|
|Absolute basophil (× 109/L)||0.01 ± 0.01||0.01 ± 0.01||P>0.05|
|RBC (× 1012 /L)||4.16 ± 0.82||4.62 ± 0.54||P<0.05|
|Haemoglobin (g/dL)||12.90 ± 1.30||14.70 ± 1.76||P<0.05|
|PCV (%)||38.70 ± 3.82||44.10 ± 6.36||P<0.05|
|MCV (fl)||87.40 ± 8.34||92.00 ± 10.21||P<0.05|
|MCH (pg)||31.00 ± 2.86||33.40 ± 1.34||P<0.05|
|MCHC (g/l)||355.00 ± 20.02||358.02 ± 17.61||P<0.05|
|Platelet (× 109/L)||341.00 ± 26.29||310.00 ± 15.06||P<0.05|
WBC: Total White Blood cell; RBC: Red Blood Cell; PCV: Packed Cell Volume; MCV: Mean Cell Volume; MCH: Mean Cell Haemoglobin; MCHC: Mean Cell Haemoglobin Concentration
Table 1: Showing haematological parameters of the cerebral malaria subjects and the control.
The study showed elevation in total white cell and platelets of the cerebral malaria subjects compared to the control and reduced red blood cells, haemoglobin, packed cell volume, cell volume, mean cell haemoglobin and mean cell haemoglobin concentration. This shows that cerebral malaria stimulates the release of leucocytes as a result of infection and stress. The red cell line is reduced significantly showing that anaemia may be one of the consequences of cerebral malaria to the patients. The bone marrow activity may be suppressed and there may be increased destruction of red cells by the reticuloendothelial system.
Falciparum malaria is associated with life-threatening complications in children . It is important for the clinicians in tropical countries to be alert for the symptoms and signs which may progress to life-threatening disease of falciparum malaria [8,9]. The high index of suspicion is rewarding most of the times because the disease has bizarre manifestations, especially in young children; septicaemia and encephalitis illnesses predominate .
Anaemia is the important cause for morbidity and mortality in falciparum malaria as seen with this study. The pathogenesis of anaemia in malaria is multifactorial. A complex chain of pathogenetic processes involving mechanical destruction of parasitized RBCs, marrow suppression, ineffective erythropoiesis, and accelerated immune destruction of nonparasitized RBCs have been implicated . Thrombocytopenia was a common observation in falciparum malaria with spontaneous recovery on treatment but in this study, it showed increased thrombocytes. Both leucopenia and leukocytosis have been described in malaria [12,13] but showed significant increase in this study.
Those suffering from this complication of malaria should receive full attention and the haematological parameters should be monitored especially the red cell line which may lead to increase morbidity and mortality. The relatives of the patients should have prompt response in taking them to the hospital when there is any sign of malaria infection so that treatment can commence early and avert the danger associated with cerebral malaria. More enlightenment campaign should be carried out especially to the rural areas and ways of prevention of malaria infection discussed to the populace.
Malaria infection is a serious public heath challenge to humanity in this part of the World with its devastating effects in the entire human systems including the haematological system. Cerebral malaria is seen to impact significantly on the total white cell, red blood cell, packed cell volume, mean cell volume, mean cell heamoglobin, mean cell haemoglobin concentration and platelets. It shows that it may lead to anaemia with it degenerative impact and suppresses bone marrow activity. Adequate health care should be provided to the patients. More attention should be given to prevention of malaria to avoid cerebral malaria as a serious complication and prompt action taken for those infected.