Role of Platelet Indices as a Potential Marker for Malaria Severity

Exploring Mean Platelet Volume and Platelet Count Recovery in Dengue Patients: Findings From an Observational Retrospective Clinical Study

Introduction Mean platelet volume (MPV) measures platelet size in the blood, which is important because dengue fever often leads to low platelet counts, especially during the critical phase. However, predicting when a patient's platelet count will recover is challenging due to the lack of clinical data. MPV may offer a solution as it tends to rise when platelet counts fall, suggesting a possible link to bone marrow activity. This study aims to understand how MPV changes during the three phases of dengue fever and how it relates to platelet count recovery. Successful results could provide valuable markers for clinicians, helping improve patient care and management. Material The study was carried out in the Department of Medicine, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India. The patients who were admitted with dengue fever/dengue haemorrhagic fever in the month of July 2023 were analysed. Observations A total of 130 patients were analysed. The average (avg) MPV on day one was 10.85 ± 1.56, on day three was 10 ± 1.48, and on day five was 9.80 ± 1.30. The avg. total platelet on day one was 119476.92 ± 78,107.78, on day three was 119000 ± 59962.52, and on day five was 169200 ± 100839.84. The correlation between MPV and platelet on day one was r= -0.22, p=0.011, which was statistically significant; on day three was r= -0.32, p=0.0001, which was statistically significant, and on day five was r= -0.30, p= 0.0004, which was statistically significant. Conclusion These findings suggest that as dengue fever progresses, MPV tends to increase as platelet counts decline. This information can be beneficial in clinical practice as it highlights the potential utility of MPV as a predictive marker for platelet recovery, aiding healthcare providers in the timely management of dengue patients to mitigate bleeding risks.

Haematological Profile in Patients With Acute Falciparum Malaria: A Hospital-Based Study

Introduction Malaria is the most common parasitic disease affecting humans. Haematological alterations in malaria are expected, and these changes play a significant role in fatal complications. The present study aims to assess the clinical and haematological profile in patients with acute falciparum malaria and the significance of various haematological and coagulation alterations with the clinical severity of malaria. Methods The prospective cross-sectional study included 68 acute falciparum malaria cases. Thick and thin blood film microscopy and a rapid diagnostic kit were used to diagnose malaria. The cases were subjected to various haematological and biochemical investigations. Bone marrow aspiration samples were also collected. Using appropriate statistical methods, the findings were compared between severe and uncomplicated malaria cases. A p-value below 0.05 was considered significant. Results The participants' ages ranged from 14 to 78. Most participants (n = 51, 75%) were male and belonged to the lower income group (33, 48.5%). Significant variations in mean parasite count between severe and uncomplicated malaria cases (p-value < 0.01) were observed. The severe and uncomplicated groups showed significant differences in haemoglobin (gm/dL), haematocrit, red blood cell count, reticulocyte, serum iron, and ESR levels (p-value < 0.05). The severe malaria group had considerably reduced mean platelet counts (p-value < 0.01). Only five instances (7.3%) had an appropriate erythropoietic response after day 28. Erythroid hyperplasia with dyserythropoietic alterations was most common in patients with severe anaemia and low-grade parasitaemia. Conclusion Acute falciparum malaria is often associated with haematological alterations. Anaemia and thrombocytopenia were the most expected alterations associated with disease prognosis and mortality.

Status of selected biochemical and coagulation profiles and platelet count in malaria and malaria-Schistosoma mansoni co-infection among patients attending at Dembiya selected Health Institutions, Northwest Ethiopia

Malaria and schistosomiasis are infectious diseases that cause coagulation disorders, biochemical abnormalities, and thrombocytopenia. Malaria and Schistosoma mansoni co-infection cause exacerbations of health consequences and co-morbidities.This study aimed to compare the effect of malaria and Schistosoma mansoni co-infection and malaria infection on selected biochemical and coagulation profiles, and platelet count. An institutional-based comparative cross-sectional study was conducted from March 30 to August 10, 2022. A total of 70 individuals were enrolled in the study using a convenient sampling technique. Wet mount and Kato Katz techniques were conducted to detect Schistosoma mansoni in a stool sample. Blood films were prepared for the detection of plasmodium. The data was coded and entered into EpiData version 3.1 before being analyzed with SPSS version 25. An independent t test was used during data analysis. A P-value of less than 0.05 was considered statistically significant. The mean [SD] of alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, and direct bilirubin in the co-infected was higher than in malaria infected participants. However, the mean of total protein and glucose in co-infected was lower than in the malaria infected participants. The mean of prothrombin time, international normalization ratio, and activated partial thromboplastin time in co-infected was significantly higher, while the platelet count was lower compared to malaria infected participants. Biochemical and coagulation profiles, and platelet count status in co-infection were changed compared to malaria infected participants. Therefore, biochemical and coagulation profiles and platelet count tests should be used to monitor and manage co-infection related complications and to reduce co-infection associated morbidity and mortality.

Circulating platelets and malaria severity: two sides of the same coin among inhabitants of a tropical savannah region, Nigeria

Changes in circulating platelets during different grades of malaria are of major concerns, and its etiology is poorly understood. We appraised and evaluated the role of circulating platelets in the determination of the severity of malaria among a cohort of outpatients living in Ilorin, Nigeria. A hospital-based case-control study of outpatients visiting public health facilities within the locality voluntarily enrolled for this study. Blood samples from 1162 malaise patients were screened using routine microscopy for Plasmodium parasite species identification, and their respective circulating platelet levels were determined. Seven hundred and seventy-five individuals (775, 66.7%, p<0.001) were malaria-positive. Samples from 387 (33.3%) uninfected healthy individuals were used as controls. Individuals with uncomplicated malaria (UCM) and complicated malaria (CM) across age group were notable (p<0.05). Children ≤5 years had the highest number of individuals with CM (103, 45.2%) with a relative risk ratio of 4.005 (95% CI: 2.964-5.413). UCM (471, 40.5%) occurred more than CM (304, 26.2%) (p>0.05) across the groups. The geometric mean, 95% CI, median, and IQR of populations with malaria thrombocytopenia were higher (181, 110.94±2.207, 106.59-115.30, 118.00, and 39.00) than thrombocytosis (78, 624.64±13.131, 598.49-650.79, 623.00, and 208). Seemingly, health controls recorded insignificant morbidity with respect to platelet counts. High P. falciparum parasitemia is inversely correlated with platelet count, and its' morbidity is associated with the manifestation of several malaria pathogenesis. Thrombocytopenia is a silent pathophysiological attribute that can trigger other cofactors during severe malaria disease. Although further studies are pertinent in order to specifically clarify its relevance to clinical disease spectrum.

Hematological Abnormalities Among Malaria Infected Adult Patients in Association with ABO Blood Groups at Jinella Health Center, Harar, Eastern Ethiopia

Background

Hematological abnormalities are a common complication of malaria infection. However, there is a paucity of evidence regarding it among malaria-infected adult patients in association with the ABO blood group in Ethiopia, particularly in the Harari Region. Therefore, this study aimed to assess the hematological abnormalities among malaria-infected adult patients in association with ABO blood groups at Jinella Health Center, Harar, Eastern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted from July 10, 2022, to January 10, 2023. Four milliliters of venous blood were collected from each study participant. Drops of blood were used for blood film preparation. ABO blood group was determined by agglutination test using monoclonal anti-sera (Agape Diagnostics Ltd., India). A complete blood count was done using the DxH 800 (Beckman Coulter, Inc, Miami, FL) hematology analyzer. The data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression models were fitted. The level of significance was declared at a p-value of <0.05.

Results

The study revealed that 47.2% (95% CI: 41.0 53.6) of the participants were anemic. Being female (AOR = 3.18, 95% CI = 1.67, 6.04), having the A blood group (AOR = 2.75, CI = 1.20, 6.31), and being infected with P. falciparum (AOR = 2.64, CI = 1.26, 5.53) were all significantly associated with malaria anemia. The overall prevalence of thrombocytopenia was also 67.7% (95% CI: 61.7-73.4%). It was significantly associated with P. falciparum infection (AOR = 8.03, CI = 3.53, 18.25) and high parasitemia levels (AOR = 4.40, CI = 1.57, 12.32).

Conclusion

Patients with malaria who belonged to the "A" blood group in the study area had anemia as a serious health problem. Hence, frequently checking for anemia in patients with malaria who have blood group "A" can help with early detection and better management of anemia.

Investigating the association between various platelet indices and different clinical sub-groups of severe malaria

Aim

To evaluate the ability of platelet count, mean platelet volume, platelet distribution width, and platelet mass index to predict the severity of malaria.

Materials and Methods

This study was conducted as a retrospective cohort study at a tertiary hospital in Somali. Patients grouped as severe and non-severe malaria. We compared groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index.

Results

A total of 131 patients were included in the final analysis. Of the patients, 77 (58.7%) had non-severe malaria, and 54 (41.3%) had severe malaria. The multivariate analysis revealed that there was no significant difference between the groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index (p: 0.183, 0.323, 0.204, and 0.139, respectively). In the receiver operating characteristic analysis, the area under the curve values for platelet count, mean platelet volume, platelet distribution width, and platelet mass index were 0.699, 0.619, 0.504, and 0.675, respectively.

Conclusion

Of the platelet indices, platelet count, mean platelet volume, platelet distribution width, and platelet mass index were not clinically significant markers that could be used to predict the severity of malaria.

Platelet Parameters and Their Correlation with Parasitemia Levels Among Malaria Infected Adult Patients at Jinella Health Center, Harar, Eastern Ethiopia: Comparative Cross-Sectional Study

Background

Malaria is a major public health problem with the highest morbidity and mortality in developing countries. Hematological changes play a great role in malaria pathogenesis through platelets and platelet parameters. However, the changes in platelet parameters are not clearly described in Ethiopia. Therefore, this study aimed to compare platelet parameters and their correlation with parasitemia among malaria-infected adult patients and healthy adults.

Methods

An institutional-based comparative cross-sectional study was conducted involving 186 (93 malaria-infected patients and 93 healthy adults) study participants using a convenient sampling technique at Jinella health center, Harar, Eastern Ethiopia, from July 10-August 10, 2022. Five milliliters of venous blood were collected from each study participant, and platelet parameters were analyzed using a Unicel (DxH 800) automated hematologic analyzer. A drop of blood was taken from malaria-suspected patients for blood film preparation. Results between two groups were compared using the Mann-Whitney U-test. Spearman's rank correlation coefficient was used to evaluate the relationships between two continuous variables. A P-value of < 0.05 was considered statistically significant.

Results

Platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults (103 x103cells/μL vs 268 x103cells/μL, 0.13 fl vs 0.23 fl, and 9.6 fl vs 15.3 fl), respectively). Conversely, platelet distribution width and platelet large cell ratio were higher in malaria-infected patients than healthy adults (19.2% vs 15.3% and 0.35% vs 0.29%), respectively). Parasitemia levels had a moderately inverse correlation with platelet count (r= -0.419) and a weakly positive correlation with mean platelet volume (r=0.278).

Conclusion

The platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults. Malaria parasitemia had a moderate inverse correlation with platelet count and a weak positive correlation with mean platelet volume. Thrombocytopenia and alteration of platelet parameters should be considered in malaria patients.

Role of platelet indices as diagnostic and predictive biomarkers for comorbidity of diabetes and metabolic syndrome in southern Ethiopia: A comparative cross-sectional study

BACKGROUND

Metabolic syndromes (MetS) and diabetes mellitus (DM) comorbidity is a growing major global public health problem with huge morbidity and mortality. It is a pro-inflammatory and prothrombotic disorder characterized by alteration of platelet indices and increased platelet activation, however, the tendency to use them in diagnosis is not yet fully evaluated in our context and there is limited evidence on the role of platelet indices in predicting and differentiating DM+MetS comorbidity in Ethiopia. Thus, this study aimed to evaluate platelet indices in HC, DM, and DM+MetS, and to determine their role in the prediction of DM+MetS comorbidity risk and the distinction between DM+MetS and DM or healthy persons in southwest Ethiopia.

METHOD AND MATERIALS

A comparative cross-sectional study was conducted in Wolkite University specialized hospital from March to August 2021. A total of 336 study participants (112 healthy controls (HC), 112 DM, 112 DM+MetS) was included in this study. Anthropmetric data were measured and the venous blood sample was collected to determine platelet indices, lipid profiles, and blood glucose levels. The SPSS version 21 statistical software was used to perform receiver operating curve (ROC), one-way ANOVA, and independent T-test analysis. The p-value for statistical significance was set at <0.05.

RESULT

In the present study, we found a significant difference in the mean value of PLT, MPV, and PDW between DM+MetS, DM, and HC. A statistically significant difference in the mean value of MPV and PDW was observed between HC and DM+MetS as well as DM and DM+MetS (p-value<0.001). At the cutoff value of 9.65fl with a sensitivity of 81.3% and a specificity of 67.9%, MPV differentiates DM+MetS from HC with an AUC of 0.859. MPV can differentiate DM+MetS from DM at a cutoff value of 10.05fl with sensitivity, specificity, and an AUC of 67.9%, 65.2%, and 0.675, respectively. At the cutoff value of 9.65fl with a sensitivity of 69.6% and a specificity of 67.9%, MPV differentiates DM from HC with an AUC of 0.747. The best platelet parameter identified in this study for predicting the presence of DM+MetS comorbidity was MPV (AUC=0.859; 95%CI=0.81-0.90).

CONCLUSION

In this study, a significant difference in the mean value of PLT, MPV, and PDW was found between DM+MetS, DM, and HC. The mean value of platelet indices showed significant increases in DM+MetS patients in comparison to HC and DM. MPV has been identified as a good potential marker to predict DM+MetS comorbidity and to differentiate DM+MetS comorbidity from the HC or DM. Our results show that MPV could be a good hematological marker to differentiate DM+MetS comorbidity from the HC or DM, and may offer supportive information for early diagnosis, prevention, and control. Thus, the findings of this study should be taken into account for the prevention and control of DM+MetS comorbidity.

Molecular mechanisms of hematological and biochemical alterations in malaria: A review

Malaria is a dangerous disease that contributes to millions of hospital visits and hundreds of thousands of deaths, especially in children residing in sub-Saharan Africa. Although several interventions such as vector control, case detection, and treatment are already in place, there is no substantive reduction in the disease burden. Several studies in the past have reported the emergence of resistant strains of malaria parasites (MPs) and mosquitoes, and poor adherence and inaccessibility to effective antimalarial drugs as the major factors for this persistent menace of malaria infections. Moreover, victory against MP infections for many years has been hampered by an incomplete understanding of the complex nature of malaria pathogenesis. Very recent studies have identified different complex interactions and hematological alterations induced by malaria parasites. However, no studies have hybridized these alterations for a better understanding of Malaria pathogenesis. Hence, this review thoroughly discusses the molecular mechanisms of all reported hematological and biochemical alterations induced by MPs infections. Specifically, the mechanisms in which MP-infection induces anemia, thrombocytopenia, leukopenia, dyslipidemia, hypoglycemia, oxidative stress, and liver and kidney malfunctions were presented. The study also discussed how MPs evade the host's immune response and suggested strategies to limit evasion of the host's immune response to combat malaria and its complications.