The patterns of Osmotic Fragility and Thrombocytopenia in Nigerian Children with Acute Plasmidium Falciparum Malaria before and after Chemotherapy

Abstract

The clinical and case management application of erythrocyte osmotic fragility and peripheral blood platelets were investigated in 40 healthy children (N=40; M/F = 20/ 20 mean age 6.2 + 3.7 years) and103 falciparum malaria children with severe anaemia (N = 41; M/F=22/19; mean age = 5.3 + 1.5) cerebal malaria (N = 16; M/F = 10/6; mean age = 3.8 + 0.7 ) and uncomplicated malaria (N =46; M/F = 21/25; mean age = 7.4 + 1.3). At presentation, thrombocytopenia (platelet count < 150 x 109/L) was found in all the children with cerebral malaria, 14 children with severe anemia and 8 of the 46 children with uncomplicated malaria. Three out of the forty healthy controls also had thrombocytopenia aside parasitaemia. Thrombocytopenia in severe malaria was significantly higher than that in uncomplicated malaria (X2 = 6.4 – 13.7; P < 0.05). At day 3 to 4 of treatment with quinine, parasitaemia became zero in all the malaria subjects but resolution of thrombocytopenia and osmotic fragility (except in uncomplicated malaria) to normalcy was incomplete. However, at day 10 after schizonticidal intervention, osmotic MCFs of all the malarial children fell within the normal range and were not significantly different (P>0.05) from that of healthy children. Thrombocytopenia also reduced substantially from 100% to 14.30% in cerebral malaria, 34.1% to 7.30% in severe anaemia and 17.4% to 4.30% in uncomplicated malaria.
It was concluded that effective management of acute P. Falciparum malaria in Nigerian children is a combination of good therapeutic response and substantial recovery from acute illness, which can be adequately assessed by monitoring parasite clearance; osmotic fragility and platelet count patterns.
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NQJHM Vol. 14 (3&4) 2004: pp. 251-256