Abstract:
Background: Hematological changes are some of the most common complications in malaria.
Severe malarial anemia is the most prominent one particularly in children and is associated with
higher prevalence of hemozoin-containing monocytes.
Objective:To determine the hematological parameters and hemozoin-containing leukocytes in
children with malaria and their association with disease severity at Pawe General Hospital,
Northwest Ethiopia.
Methods:A facility-based across sectional study was conducted at Pawe General Hospital from
July 30 to December 31, 2014. A total of 377 malaria infected children aged from 1 to 15 years
were recruited for the study. Demographic and clinical data were collected using structured
questionnaire. 4 ml venous blood was collected from each patient for complete blood count and
blood film preparation. Thick blood film was stained by 10% Giemsa for malaria parasite
detection and to determine parasitemia whereas intraleukocytic malaria pigment was detected
and enumerated from thin films. The complete blood count was analyzed using CELL-DYNE
1800® (Abott diag, USA). In addition children were screened for HIV-1/2 status and intestinal
parasites. Statistical analysis of the data (student’s t-test, chi square, ANOVA and Pearson
correlation) was done using SPSS V-20 statistical software.
Results:Anemia and thrombocytopenia were found in 40.3% and 56.8% of malaria infected
children whereas leukocytosis and leukopenia in 15.4% and 10.3% of malaria infected children,
respectively. Hemozoin containing -monocytes and -neutrophils were found in 80.1% and 58.9%
of the study subjects, respectively. Anemia (x2=17.8, p<0.001), leukocytosis (x2=11.0, p=0.001),
HCM (x2=19.72, p<0.001) and HCN (x2=7.91, p=0.005) were significantly associated with
severity of malaria. However, thrombocytopenia (x2=0.2, p=0.623), severe thrombocytopenia
(x2=0.035, p=0.851) and leukopenia (x2=3.0, p=0.09) were not associated with severity of
malaria. The mean percentage of monocytes-containing hemozoin was significantly associated
with the severity of malarial anemia (p<0.001). Parasitaemia was negatively correlated with
hemoglobin (r=-0.117, p=0.023) and positively with white blood cell count (r=0.21, p<0.001),
mean hemozoin containing–monocytes (r=0.343, p<0.001) and hemozoin containing–
neutrophils (r=0.414, p<0.001), but was not correlated with platelet count (r=-0.050, p=0.335).II
Conclusion: Anemia, thrombocytopenia, hemozoin-containing monocytes and hemozoincontaining neutrophils were the most common hematological abnormalities in children infected
with malaria. Anemia, leukocytosis, hemozoin-containing monocytes and hemozoin-containing
neutrophils were significantly associated with severe malaria. Furthermore, mean percentage of
HCMs >16.2 and HCNs >2.7 may be used as indicators of severe malaria. Beside parasite
density; findings of anemia, leukocytosis, the presence and quantities of hemozoin-containing
monocytes and hemozoin-containing neutrophils were hematological indictors suggestive of
severe malaria in children residing in malaria endemic areas.
