Transcript effect of malaria infection on packed cell volume and haemoglobin

TITLE: EFFECT OF MALARIA INFECTION
ON PACKED CELL VOLUME AND
HAEMOGLOBIN LEVELS AMONG
PATIENTS AT OJO DISTRICT OF LAGOS
STATE NIGERIA.
IWUNZE VINCENT, NNEKA ELOTA, OKEY OWO
Life – link Medical Diagnostic & labs Ltd
ABSTRACT
Malaria is a worldwide migrating diseases associated
with anaemia especially in the tropical Africa. It causes
high rate of mortality and morbidity among SubSaharan Africans. Anaemia is a Hematological disorder
caused by a decrease in the production of Red blood
cells, a born marrow failure or by an increase in the
Red blood cells destruction. The study is to evaluate
the effect of malaria infection on the Packed cell
volume and haemoglobin levels of patients. Blood
samples were collected in EDTA bottles from patients
attending Life-link Medical Diagnostic and Laboratories
Ltd and Patients from Ojo health Center, all in Ojo
District of Lagos state Nigeria. Presence or absence of
malaria identified by staining with Giemsa stain and
examined under oil immersion , PCV and Hb were
estimated using Hawskley Haematocrit machine and
Microfield colorimeter respectively.
• A total of 250 patients were studied between
June to October 2013, 180 (72%) malaria
infected patients, 160 (89% Adult), 20 (11%
children) and 70 (28%) of non-infected. The
overall means for the Packed Cell volume and
Haemoglobin showed a significant difference
in malaria infected patients.
• The mean Hb, PCV in infected were lower
than the non infected. Conclusively, there was
a decrease in Packed cell volume and
Haemoglobin which seems to be due to the
excessive destruction of of Red blood cells by
the malaria parasite.
BIOGRAPHY
• IWUNZE VINCENT OKECHUKWU graduated from the
University of Calabar, Cross River state Nigeria in 1991.
He specialized on Haematology and Blood Transfusion.
Presently he is the MD/CEO of Life-link Medical
Diagnostic and Laboratories Nigeria Ltd, one of the fast
growing Diagnostic and Research Centers in the
country. It is situated at the former capital of Nigeria,
Lagos, the commercial hurb center of Africa. He has
delivered many scientific papers on some conferences
especially in Nigeria. He has also headed many
scientific workshops and served in different Ad-Hoc
committees. He is working with his team to contribute
their quota to the profession of Haematology research.
INTRODUCTION
• Malaria is a worldwide migrating health diseases especially in
many developing countries e.g Africa and Asia. It was first
isolated in blood of a patient in 1881 by Alpores Laveren.
Malaria is gotten if bitten by an infected anophelene mosquito,
if one receives infected blood from someone during blood
transfusion and from mother to child during pregnancy. The
causative agent of malaria is Plasmodium which is made up of
four species; Plasmodium Falciparium. Plasmodium Vivax,
Plasmodium Ovale and Plasmodium Malariae. Plasmodium is a
single celled parasite that multiplies in the red blood cells of
human and mosquito. The two most common species in Africa
are Plasmodium Vivax and Plasmodium Falciparium with P
Falciparium more pathogenic with high morbidity and mortality
rate in Sub-Saharan Africa. P. Falciparium modifies the surface of
RBC causing it to become sticky. This nature makes the cells to
stick to the walls of the vessels leading up to major organs
• like the brain. This build up is called “Sequestration”
and results in reduced blood flow and oxygen
deprivation in the organs hence causing anaemia and
eventual death of the patient. Anaemia is a blood
disorder and one of the fatal consequences of
malaria infection in the whole world. The
pathophysiology of anaemia caused by plasmodium
falciparium is both complex and multifactorial and
results in a condition which is a major cause of high
mortality and morbidity in patients.
• According to World Health Organization 2013, 3.4
billion people ( half of world population) live in areas
at risk of malaria transmission in 106 countries and
territories. Report also had it that in 2012, malaria
caused an estimated 207 million clinical episodes and
627,000 death yearly. An estimated 91% of death in
2010 were in the African region.
•
MATERIALS AND METHOD
• SAMPLE COLLECTION; Venous Blood samples were collected
in EDTA containers and test carried out the same day.
• MATERIALS: Glass slide, Capillary tubes, Colorimeter,
Drabkin,s solution, Haematocrit Centrifuge and reader, Test
tubes. Automatic pipettes
•
METHOD
• PACKED CELL VOLUME: It is the proportion of whole blood
occupied by the red cells expressed in percentage. It is used
for the measurement of anaemia.
• PRINCIPLE: Anticoagulated blood in a glass capillary of
specified length, bore size and wall –thickness is centrifuged
in a microhaematocrit centrifuge at RCF 12000-15000 xg for 35 minutes to obtain a constant packing of the cells . The PCV
value is read from the scale of a microhaematocrit reader.
HAEMOGLOBIN ESTIMATION: Measurement of
haemoglobin concentration in a blood is a basic
screen for anaemia and its severity or for
polycythaemia.
PRINCIPLE: Blood is diluted 1 in 201 in a solution
containing potassium cyanide and potassium
ferricyanide (Drabkins solution). The red cells are
haemolyzed and the haemoglobin is oxidized by the
ferricyanide to methaemoglobin. This is converted by
cyanide to more stable haemoglobincyanide (HiCN).
The absorbance of the solution is read in a
Microfield colorimeter at 540nm wavelength. The
absorbance obtained is compared with that of the
reference standard on a haemoglobin chart
prepared from a calibration graph.
•
STATISTICAL ANALYSIS
• The descriptive data were given as Mean ±
Standard Deviation SD. Independent student
t-test was used to test and compare the
significance of the difference between Mean
values. The Pearson Chi Square test was used
for analytical assessment and the differences
were considered to be statistically significant
when the P- values obtained was ≤ 0.05.
Packed Cell volume is considered to the Hb in
this evaluation.
Table 1; Showing PCV and Hb values with the mean and Standard
Error of mean values of male and female adults.
ADULT MALE
GROUP
PCV
ADULT FEMALE
Hb
PCV
Hb
CONTROL
43.08±1.57 13.68±0.52
33.1±0.98
10.36±0.32
POSITIVE
for malaria
31.93±3.58
17.40±3.54
11.08±0.53
9.96±1.18
Table 2; Showing PCV and Hb values with the mean and Standard Error
of mean values of male and female children
MALE CHILDREN
GROUP
PCV
Hb
FEMALE CHILDREN
PCV
Hb
CONTROL
21.74±3.88
6.57±1.29
31.93±3.59
9.96±1.18
POSITIVE
for malaria
17.4±3.54
4.91±1.13
43.08±1.57
13.68±0.52
Table 3; Showing comparism between GROUP 1&2, GROUP 3&4.
GROUP
GROUP 1-(control
for male adult)
And
GROUP 2-(malaria
positive for male
adult)
GROUP 3-(control
for female adult)
And
GROUP 4-(malaria
positive for female
adult)
MEAN
STANDARD
DEVIATION
11.16
21.23
15.72
21.05
STANDARD
ERROR OF MEAN
3.75
3.72
SIG.- (2TAILED)
0.006*
0.000*
A STATISTICAL SIGNIFICANT DIFFERENCE WAS SEEN BETWEEN THE GROUPS. KEY; *P < 0.05
**P <0.01
TABLE 4: Showing comparism between GROUP 5&6, GROUP 7&8
GROUP
GROUP 5-(control
for male children)
And
GROUP 6-(malaria
positive for male
children)
GROUP 7-(control
for female
children)
GROUP 8-(malaria
positive for female
children)
MEAN
STANDARD
DEVIATION
4,34
10.81
−8.84
17.54
.
STANDARD DEVIATION SIG.-(2OF ERROR
TAILED)
1.91
3.10
0.030*
0.008*
A STATISTICAL SIGNIFICANT DIFFERENCE WAS SEEN BETWEEN THE GROUPS. KEY; *P < 0.05
**P <0.01
•
DISCUSSION
•The table above demonstrated that malaria caused more destruction
of Red blood cells in male positive children in table 2 than the control
male adult in table 1. It was also statistically significant (P<0.05) when
the Haemoglobin values were compared. There was an insignificant
difference between the control adult Female in group 3 and positive
female children in group 4 with two-tailed P values less than 0.05.
Packed cell volume values of control male children in group 5 and
positive male children in group 6 had two-tailed P values less than
0.05 and by conventional criteria , this difference is considered to be
very statistically significant. They also had Haemoglobin values which
showed P values less than 0.05 thus was statistically significant. In
group 7 , PCV for control female children and group 8 for positive
female children , there is a significant difference with two-tailed P value
of 0.05 and also had Haemoglobin values with P greater than 0.05
thus was statistically significant.
•The significant difference seen between the Packed cell volume
values of the control groups and the positive groups is due to the
increased destruction and reduced production of the Red blood cells.
CONCLUSION
• The result in this research work showed that the P values of the
Packed cell volume and Haemoglobin values for control and
positive malaria patients studied from Ojo district of Lagos
Nigeria was statistically significant thus a difference was
established between malaria positive and non malaria patients
which were used as a control group. This study have proved
other studies done which showed a decrease in PCV and
Haemoglobin levels of malaria positive subjects. It has also
established presence of critical anaemia in patients with malaria
parasitaemia.
• Studies conducted in areas of stable, perennial malaria
transmission in Tanzania, Cameroon and Kenya, showed that
malarial infection correlates with decline in haemoglobin
concentration of less than 7 gl/dl.
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