Prognostic Implications of White Cell Differential Count and White Cell Morphology in Malaria

Abstract

BACKGROUND: Malaria is of immense importance amongst the tropical\ndiseases in India. There is a need to develop newer diagnostic aids and\nresearch is necessary to identify new prognostic markers for prediction\nof the course and complications. AIMS: To evaluate the white cell\ndifferential count and morphology in Plasmodium vivax and Plasmodium\nfalciparum malaria and study their prognostic utility. SUBJECTS AND\nMETHODS: Two hundred and sixty-four adult patients in the age range of\n20 to 65 years presenting to the hospital over a period of 4 months\nwith clinical features of malaria and a positive peripheral smear\nexamination were studied. RESULTS: No statistically significant\ndifference was noted in the white blood cell (WBC) count and neutrophil\ncount in P.vivax versus P. falciparum malaria. Band cells were more\nfrequently noted in P. falciparum malaria than in P.vivax malaria (p\n< 0.0001). Toxic granulation of the neutrophils was noted in 9.5% of\nthe patients and exclusively in P. falciparum malaria. Presence of\ntoxic granulation of the polymorphs in subjects with P. falciparum\nmalaria was significantly associated with anaemia (p=0.019), jaundice,\ncerebral involvement, adult respiratory distress syndromes, renal\ndysfunction and death (p < 0.0001 for all these parameters).\nCONCLUSION: Band cells were seen in P. vivax and P. falciparum malaria,\nalthough in higher numbers in P. falciparum malaria. Toxic granulation\nof the neutrophils was noted only in the presence of P. falciparum\nmalaria in this study and correlated with severity.