Clinical Correlation of coagulopathy in vivax malaria
Keywords:
Malaria, Coagulation, PT, aPTT
Abstract
Background: Malaria is a disease with a great global burden. Understanding the pathogenesis of the disease with particular emphasis on the complications is necessary. The coagulation system plays a key role in the pathogenesis of complicated as well as uncomplicated malaria. Pathogenesis of vivax malaria is less focused upon as compared to that of falciparum malaria and studies on the role of coagulation have yielded conflicting results .Aims: To study the prothrombin time (PT ) and activated partial thromboplastin time (aPTT) in malaria with focus on vivax cases to determine the presence or absence of coagulation abnormalitie and to correlate these with the clinical features.Settings and Design: Hospital based prospective cross-sectional study.Methods: A single citrated blood sample of patients diagnosed with falciparum and vivax malaria was analysed in semi-automated coagulation analyzer at the time of presentation.. The values were compared with healthy controls. Correlations with clinical features and effect of treatment on coagulation profile have been studied. Data was analyzed by mean standard deviation and by ‘t’ test using SPSS software version 16 for windows. ‘p’value is obtained by Mann Whitney U testResults: Prolonged PT and aPTT was noted in vivax malaria as compared to the controls. The difference in the coagulation profile of vivax and falciparum cases was not significant. PT and aPTT were prolonged in 38% and 56% of the malaria patients. The sample obtained at the time of presentation had no significant correlation with the clinical symptoms, antimalarial treatment and complications.Conclusions: Coagulation is involved in the early stages pathogensis of vivax malaria to the same extent as falciparum malaria.References
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15. Mast Q , Groot E, Asih PB, Syafruddin D, Oosting M, SebastianS , Ferwerda B, Netea MG, de Groot PG, van der Ven AJAM, Fijnheer R Am. J. Trop. Med. Hyg. 2009; 80(3):492–498
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19. Srinivas D,Behera AK, Padhi PK,Barik BK.Coagulation profile in Plasmodium falciparum Malaria Infection. Paper presented at 63rd Annual Conference of Association of Physicians of India January 2008, Kochi, India. Updated on 26th June 2008 Available on :http://www.japi.org/july 2008/tropical diseases.html. accessed on 23/10/2013
20. Prasad R,Das BK, ,Shukla J, Pengoria R,MishaOP Singh TB. Coagulation status and platelet functions in children with severe falciparum malaria and their correlation of outcome. J Trop Pediatr 2009 Dec;55(6):374-378
21. Netha SB. Clinical,Hematological and Coagulation Profile in Malaria. Available on http://119.82.96.198:8080/jspui/handle/123456789/1237 f. Accessed on 23/10/2013
22. Skudowitz RB, Katz J, Lurie A, Levin J, Metz J. Mechanisms of thrombocytopenia in malignant tertian malaria. Br Med J 1973;2:515–518.
2. Wickramasinghe SN, Abdalla SH. Blood and bone marrow changes in malaria. Ballier’s Clin Hematol. Harcourt Pub Ltd:2000:13:277-299
3. Miller LH, Baruch DI, Marsh K, Doumbo OK. The pathogenic basis of malaria NATURE 2002; 415: 673-674
4. Baruch DI, Pasloske BL, Singh HB, Bi X, Ma XC, Feldman M, Taraschi TF, Howard RJ. Cloning the P. falciparum gene encoding PfEMP1, a malarial variant antigen and adherence receptor on the surface of parasitized human erythrocytes. Cell 1995;82:77–87.
5. Francischetti IM, Seydel KB, Monteiro RQ. Blood coagulation, inflammation, and malaria. Microcirculation 2008 ;15(2):81-107.
6. Francischetti IMB, Seydel KB, Monteiro RQ, Whitten RO, Erexson CR, Noronha ALL, Ostera GR, Kamiza SB, Molyneux ME, Ward JM, Taylor TE. Plasmodium falciparum-infected erythrocytes induce tissue factor expression in endothelial cells and support the assembly of multimolecular coagulation complexes. J Thromb Haemost 2007; 5: 155–65.
7. Ghosh K, Shetty S. Blood coagulation in falciparum malaria. Parasitol Res 2008;102(4):571-576
8. Choia G, Schultza MJ, van der Pollb MLT The relationship between inflammation and the coagulation system Swiss Med Weekly 2006;136:139– 144
9. Angchaisuksiri P. Coagulopathy in malaria Thrombosis Research 2014; 133: 5–9
10. Levi M, van der Poll T, Büller,HR MD. Bidirectional Relation Between Inflammation and Coagulation Available at http://circ.ahajournals.org/ accessed on August 27, 2015
11. Rojanasthein S, Surakamolleart V, Boonpucknavig S, Isarangkura P. Hematological and Coagulational Studies In Malaria. J Med Assoc Thai 1992;75(1):190-194.
12. Mohanty D, Marwaha N, Ghosh K, Sharma S, Garewal G, Shah S, Devi S, Das KC. Functional and ultrastructural changes of platelets in malarial infection. Trans R Soc Trop Med Hyg 1988;82:369. [PubMed: 3068847
13. Clemens R, Pramoolsinsap C, Lorenz R, Pukrittayakamee S, Bock HL, White NJ. Activation of the coagulation cascade in severe falciparum malaria through the intrinsic pathway. Br J Haematol. 1994;87:100–105.
14. Pukrittayakamee S, Clemens R, Pramoolsinsap C, Karges HE, Vanijanonta S, Bunnag D, White NJ. . Polymorphonuclear leucocyte elastase in Plasmodium falciparum malaria. Trans. R. Soc. Trop. Med. Hyg. 1992; 86:598-601..
15. Mast Q , Groot E, Asih PB, Syafruddin D, Oosting M, SebastianS , Ferwerda B, Netea MG, de Groot PG, van der Ven AJAM, Fijnheer R Am. J. Trop. Med. Hyg. 2009; 80(3):492–498
16. Dennis LH, Eichelberger JW, Inman MM, Conrad ME.Depletion of coagulation factors in drug-resistant Plasmodium falciparum malaria..Blood ;1967: 29:713-21
17. Horstmann RD, Dietrich M. Haemostatic alterations in malaria correlate to parasitaemia. Blut.1985;51:329–335.
18. Mohanty D ,Ghosh K,Nandwani SK,Shetty S ,Phillips C,Rizvi S ,Parmar BD. . Fibrinolysis, inhibitors of blood coagulation, and monocyte derived coagulant activity in acute malaria.American Journal of Hematology1997;54(1):23-29
19. Srinivas D,Behera AK, Padhi PK,Barik BK.Coagulation profile in Plasmodium falciparum Malaria Infection. Paper presented at 63rd Annual Conference of Association of Physicians of India January 2008, Kochi, India. Updated on 26th June 2008 Available on :http://www.japi.org/july 2008/tropical diseases.html. accessed on 23/10/2013
20. Prasad R,Das BK, ,Shukla J, Pengoria R,MishaOP Singh TB. Coagulation status and platelet functions in children with severe falciparum malaria and their correlation of outcome. J Trop Pediatr 2009 Dec;55(6):374-378
21. Netha SB. Clinical,Hematological and Coagulation Profile in Malaria. Available on http://119.82.96.198:8080/jspui/handle/123456789/1237 f. Accessed on 23/10/2013
22. Skudowitz RB, Katz J, Lurie A, Levin J, Metz J. Mechanisms of thrombocytopenia in malignant tertian malaria. Br Med J 1973;2:515–518.
Published
2016-02-13
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