"Not so benign" Plasmodium vivax malaria: An appraisal

Abstract

Introduction: Plasmodium vivax infection-associated hematological changes including severe anemia can cause significant morbidity and indirect mortality. Objective: The objective of the study is to analyze hematological changes in P. vivax malaria patients and to review pathogenesis and cause of death in P. vivax infection. Materials and Methods: During a 1-year period, patients who were screened and confirmed as P. vivax by quantitative buffy coat and peripheral smear were included in the study. The demographic details and hematological profile (hemoglobin, total white blood cell count, and platelet count) were correlated. The severity of anemia was graded based on hemoglobin and correlated with parasitemia. Results: Two hundred patients were included. Twelve of them in addition showed Plasmodium falciparum. Thrombocytopenia (74.5%) was a significant feature compared to anemia (4.5%) and leukopenia (20.5%). Only three patients had hemoglobin level <6 g%. One of them (4.3 g%) developed relapse. During relapse, he had hemolytic anemia which required transfusion. He died on follow-up. All patients were treated with the first-line antimalarial drugs. Conclusions: In view of the inherent biological characteristics, P. vivax is more difficult to eradicate than P. falciparum. The pathogenesis of anemia is multifactorial including mechanical processes and immune mechanisms which enhance removal of infected and uninfected cells. This probably leads to severe anemia in the patient who died.