Abstract
BackgroundFor the calculation of parasite index (PI) by microscopy method, an assumed total leucocyte count (TLC) of 8,000/μL is used conventionally. However, due to obvious variation in the population and individual TLCs, use of 8,000/μL may result in either over/underestimation of the PI.MethodsThis study was aimed at ascertaining the utility of 8,000/μL TLC, as well as other assumed TLCs, with respect to measured TLC for the calculation of PI. A tertiary care hospital and five primary health centres were the base for the prospective study conducted among microscopically proven, symptomatic Plasmodium vivax mono-infection patients aged ≥18 years. PIs calculated by assumed TLCs ranging from 4,000-11,000/μL were compared with those calculated by measured TLCs. Geometric mean with 95% confidence interval, Bland-Altman plot and Wilcoxon signed rank test were used for statistical analysis.ResultsA total of 284 P. vivax mono-infection patients, including 156 from a tertiary care hospital and 128 from five primary health centres, were recruited in the study. Assumed TLCs below 5,000 cell/μL and above 5,500 cell/μL in tertiary care setting resulted in significant (p <0.05) underestimation and overestimation, respectively. However, in primary health centres, it was an assumed TLC of 5,000 cell/μL, below and above which there was significant (p <0.05) underestimation and overestimation observed, respectively.ConclusionsAssumed TLC of 8,000/μL is not suitable for the calculation of PI. Either actual TLC of the patient should be measured or a representative TLC should be derived for the population under investigation for any study requiring calculated PI by microscopy.
Highlights
For the calculation of parasite index (PI) by microscopy method, an assumed total leucocyte count (TLC) of 8,000/μL is used conventionally
The current study was aimed at ascertaining the applicability of the assumed TLC of 8,000/μL for the calculation of PI among Plasmodium vivax mono-infection patients attending a tertiary care hospital and five primary health centres
There was marked leucopaenia and leucocytosis among patients who attended tertiary care hospital, whereas, only leucopaenia was noted among primary health centres’ patients with upper range of TLC being within normal reference limit
Summary
For the calculation of parasite index (PI) by microscopy method, an assumed total leucocyte count (TLC) of 8,000/μL is used conventionally. There have been a few studies from across the globe [5,6,7] denying the applicability of assumed TLC of 8,000/μL for PI calculation among respective populations. There has been no study from India on this issue and the national guideline [8] advocates use of an assumed TLC of 8,000/μL for PI calculation. The current study was aimed at ascertaining the applicability of the assumed TLC of 8,000/μL for the calculation of PI among Plasmodium vivax mono-infection patients attending a tertiary care hospital and five primary health centres
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