Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s7

SYNOPSIS

Rajiv Gandhi University of Health Sciences, Bangalore , Karnataka .

“VARIATION OF HAEMATOLOGICAL INDICES IN VARIOUS TYPES

OF MALARIA”

Name of the candidate : Dr. Samith Ahmed

Guide : Dr. S V Srikar

Course and Subject : M.D. (Pathology)

Department of Pathology,

A J Institute of Medical Sciences,

Kuntikana, Mangalore . 2010

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE , KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 Name of the candidate and DR SAMITH AHMED,

address (in block letters) POST GRADUATE RESIDENT,(MD)

DEPARTMENT OF PATHOLOGY,

A J INSTITUE OF MEDICAL SCIENCES,

MANGALORE. 2 Name of the Institution A J INSTITUTE OF MEDICAL SCIENCES

MANGALORE. 3 Course of study and Subject MD PATHOLOGY. 4 Date of admission to course 10/05/2010

5 Title of the Topic

VARIATION OF HAEMATOLOGICAL INDICES IN VARIOUS

TYPES OF MALARIA

2 6 BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study

Malaria is endemic in the Indian subcontinent and parasites are

frequently detected in peripheral blood smear of patients ; though rampant

throughout the year , large number of cases are observed during monsoons ,

especially in this coastal belt . Gold standard of malaria diagnosis is

demonstration of parasite in the peripheral blood smear . However there

seems to be a co-relation between platelet count , the WBC counts , Hb ,

PCV and morphology of RBC in malaria . The aim of this study is therefore

to make a thorough inventory of the haematological indices in peripheral

blood detected positive for malarial parasites in a group of 100 cases.

6.2 Review of Literature

There seems to be monocytosis and anaemia in chronic malaria . Anaemia

progressively becomes moderate to severe . Thrombocytopenia also seems to

be a feature during malaria . ‘ Vivax’ associated thrombocytopenia is

common [1] , with multiple mechanisms resulting in peripheral destruction

and splenic sequestration [2] , the role of platelet activation , microvascular

3 aggregation and microthrombotic processes in platelet destruction in severe vivax are not understood clearly [3]. Previous studies demonstrated an increase of neutrophil count during the first two days of fever due to falciparum malaria and subsequent decrease [4] . However , other reports showed lymphopenia in some cases of acute malaria [5],[6]. PCV

(hematocrit) is usually normal during the first 24 hrs after onset of fever , the PCV continues to fall for some days after antimalarial therapy [7]. A community based study of malaria prevention in Tanzania [8] has confirmed that falciparum malaria was an important cause of childhood anaemia with

PCV falls. Severe anaemia is common among pregnant women infected with falciparum [9]. Two possible causes of this anemia are increased hemolysis or a decreased rate of erythrocyte production [10],[11].Finally , infected erythrocytes may adhere to platelets , and clumps of infected erythrocytes and platelets have been associated with severe disease [12].

Since there are clues that monocytosis, thrombocytopenia are associated with malaria and little is known about RBC morphology and PCV in malaria , the aim is to study and make a complete inventory of the various Haematological indices in malaria patients.

4 6.3 Objectives of the study

1. To study the Hb , PCV and morphology of RBCs in smears detected

positive with malaria.

2. To make a Total count and Differencial count of WBCs in the peripheral

smears of malaria patients.

3. To establish a relationship of thrombocytopenia with malaria.

7. Material and methods:

7.1 Source of data.

All peripheral smear slides subjected for malarial parasite detection

tested positive in Central Diagnostic Lab (CDL) of AJIMS, Mangalore. 100

cases will be included in this study.

7.2 Method of collection of data ( including sampling procedure, if any)

4 ml of blood is collected from the patient using sterile aseptic methods in

an EDTA vacutainer. The blood drawn is fed into the automated cell counter

where the Hb , PCV and Total counts of the WBCs are collected, with the

remaining blood peripheral smears are made which are subjected to

5 leishman’s staining. The smears are evaluated and the RBC morphology ,

differencial count of WBCs and platelet counts are done. Informed consent

of the patient for the present study is required and is duly enclosed.

Inclusion criteria: All slides of malarial parasites tested positive after

peripheral smear examination.

Exclusion criteria: Slides not having malarial parasites.

Plan for data analysis:

Statistical analysis will be done .

7.3 Does the study require any investigations or interventions to be

conducted on patients or other humans or animals? If so, please describe

briefly? – No, once the blood is drawn no more interventions are required.

7.4 Has ethical clearance been obtained from your institution:

Yes 8 LIST OF REFERENCES

1. Tan, L.K. et al. (2008) Acute lung injury and other serious complications

of Plasmodium vivax malaria. Lancet Infect. Dis.8, 449-454

2. Erhart, L.M. et al. (2004) Hematologic and clinical indices of malaria in a

semi-immune population of western Thailand. Am. J. Trop. Med. Hyg. 70,8-

3. Trends in parasitology . vol.25 no.5 pg 223

4. Abdalla SH. Peripheral blood and bone marrow leucocytes in Gambian children with malaria: numerical changes and evaluation of phagocytosis.

Ann Trop Ped 1988; 8:250-258

5. Lisse IM, Aaby P, Whittle H, KrudsenK. A community study of T lymphocytes subsets and malaria parasitaemia. Trans Roy Soc Trop Med Hyg

1994; 88:709-710

6. Kuwait Medical Journal 2007 , 39 (3):262-267

7. Pillips RE, Looareesuwan S, Warrell DA, et al . The importance of anemia in cerebral and uncomplicated falciparum malaria: role of complications, dyserythropoiesis and iron sequestration. Quarterly J Med 1986; 58:305-323.

8. Shiff C, Checkley W , Winch P, Prenji Z, Minjas J , Lubeqa P. Changes in weight gain and anemia attributable to malaria in Tanzanian children living under holoendemic conditions. Trans Roy Soc Trop Med Hyg 1996; 90:262-

9. Menendez C, Fleming AF, Alonso PL, 2000. Malaria-related anaemia.

7 Parasitol Today 16: 469-476.

10. Weatherall DJ, 1988. The anaemia of malaria. McGregor I, Wernsdorfer

WH, eds. Malaria: Principles and Practice of Malariology. New York:

Churchill Livingstone, 735-751.

11. Phillips RE, Pasvol G, 1992. Anaemia of Plasmodium falciparum

malaria. Baillieres Clin Haematol 5: 315-330.

12. Abdalla SH, 1990. Hematopoiesis in human malaria. Blood Cells 16:

401-416.

9 Signature of candidate

10 Remarks of the guide .

8 11 Name & Designation of

(in block letters) Dr. S V SRIKAR M.B.B.S, MD., 11.1 Guide ASSOCIATE PROFESSOR ,

A J INSTITUTE OF MEDICAL SCIENCES,

MANGALORE.

11.2 Signature

11.3 Head of Dr. P D BHANDARI M.B.B.S, MD., Department PROFESSOR AND HOD,

A J INSTITUTE OF MEDICAL SCIENCES,

MANGALORE

11.4 Signature

9 12 12.1 Remarks of the Chairman and Principal

12.2 Signature

10 PROFORMA

PATIENT DETAILS:

Case Number:

Clinical details:

Lab Investigation :

RBC morphology :

WBC(TC):

WBC(DC):

Platelets:

The personal details of the patients were not disclosed during any part of the study.

11 INFORMED CONSENT FORM

TITLE OF RESEARCH

VARIATION OF HAEMATOLOGICAL INDICES IN VARIOUS TYPES OF MALARIA

INVESTIGATORS: Dr. S V Srikar , Dr. Samith Ahmed

INTRODUCTION:-

You are being invited to participate in research project designed to identify the variation of blood indices in malaria .Correct diagnosis of malaria will lead to appropriate management. History taking and diagnostic tests will be used to establish the presence of malaria. You have been selected for this study because you meet the inclusion criteria of the study.

EXPLANATION OF PROCEDURES:-

In this project, if you are selected, history taking and diagnostic tests will be done.

POSSIBLE BENEFITS:

The investigators do not promise or guarantee that you will receive direct benefit from being in the

12 study. There also may be benefits involved that are not known to the researchers at this time.

POSSIBLE RISKS:-

There are no known physical risks for the child or person associated with these methods.

ALTERNATIVE PROCEDURES:-

If you don’t want to participate in the study you will receive the usual care given in the hospital.

CONFIDENTIALITY:-

The result of the study may be published for scientific purpose, however your identification will not be revealed.

WITHDRAWAL:-

Participation in the study is voluntary , if you do not wish to participate in the study you will not lose benefits to which you are entitled. You are free to withdraw your consent and discontinue your participation in this project at any time.

SIGNIFICANT NEW FINDINGS

Any significant new findings discovered during the course of the study, which may influence your decisions to continue participations, will be made known to you.

13 COSTS OF PARTICIPATIONS

The cost of the study will be covered by the investigators or by a research grant, there will be no additional cost to you for participating in this study.

PAYMENT FOR PARTICIPATION.

There will be no payment to you for participating in this study

Payment of Research Related Injuries:

If, as a result of your participation, you experience injuries from known or unknown risk of the research procedures as described, immediate care and treatment, including hospitalization if necessary, will be available. Neither investigator nor A.J. Institute of Medical Science has made provision for monetary compensation in the event of injury resulting from the research and in the event of such injury, treatment is provided, at free of charges.

QUESTIONS:

If you have any questions about this study, questions about a research related injury or experience, any problems during the study, you should contact Dr. Samith Ahmed at 9986222365 and Dr. S. V. Srikar at 9448216373 . If you have questions about your rights as a research participant, you may contact Research Ethics Committee, AJIMS, Mangalore.

14 LEGAL RIGHTS

By signing this consent form, you are not waiving any of your legal rights.

CONSENT STATEMENT

My signature below indicates that I have decided to participate in the study and that I have read (or been read) the information provided above and that I was given the opportunity to ask questions and that they have answered to my satisfaction and that I have received a copy of this signed consent form.

______

Signature or Thumb impression of patient Date

15 ______

Signature of Person Obtaining consent Date

If other than the Principal Investigator

______

Signature of Principal Investigator Date

______

Signature of Witness Date