Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Hematological changes in patients infected with Giardiasis In Al-Najaf province

Jasim H. Taher, Aya N. Hattoof, Ahmed A. Khdayer, Bader F. Hassan, Bashaaer H. Dahir, Baneen B. Hadi, Teeba A. Abed Zaid, Hasan Y. Mohammed, Safaa K. Sabeh, Akram R. Rahi, Hasaneen A.J. Moosa, Arshad A. M. Abdui Raheem

Medical Laboratory Techniques Department, Technical Institute / Kufa Al-Furat Al-Awsat Technical University

ABSTRACT The study was carried out for access to the hematological changes in patients infected with Giardia lamblia which were performed on 60 blood samples from patients infected with Giardia lamblia and 30 samples of healthy persons. The Samples were collected from patients who attended governmental hospitals: Al-Sadder Medical City, Al-Hakeem General Hospital and Al-Zahra’a Educational Hospital for Child Birth and Children for the period from November 2018 to February 2019. The following tests were performed: Mean corpuscular hemoglobin concentration (MCHC), Mean corpuscular hemoglobin (MCH), Mean corpuscular volume (MCV), Packed cell volume (PCV), Hemoglobin (Hb), Red blood cells (RBCs), White blood cells (WBCs), and platelets (PLTs). The results showed a significant increase (P >0.05) in the number of white blood cells and platelets in patients infected with Giardia lamblia in comparison with control. There was a significant decrease (P >0.05) in the PCV, MCH, MCHC, MCV, and RBCs in patients infected with Giardia Lamblia in comparison with control.

Key words: Giardiasis, PCV, MCH, MCHC, MCV and RBCs.

Introduction The intestinal parasites infection is one of the most widely known type of parasitic infection among the world (1). Since these parasites and their larval stage can be easily transmitted by contaminated food and water or by direct contact and the carelessness of the vendors of vegetables to clean the vegetables and the contamination of their hands especially in the course of transport and sale have an important role in the infections (2) and if these vegetables were irrigated with untreated sewage (3). Giardia lamblia is one of the most widely known parasites which infect humans and other mammals and the most common causative agent for diarrhea in the world (4)(5). Its incidence is 20-40% in the developing countries (6). The parasite has two phases, cyst and trophozoite (7). Giardia lamblia mainly infects mammals such as humans, cats, dogs and cows (8). The parasite is released from the cyst because of gastric acidity and gastric enzymes (9). The trophozoite attaches itself to the surface of the intestinal epithelium by the ventral sucking disk and then reproduces by binary fission (10). The factors contributing to the presence of clinical features vary depending on the virulence of the parasite strains, numbers of cysts, age of the host and the status of the immune system through infection (11). Some patients with giardiasis has subnormal values of certain blood parameters due to absorption of vitamin B12 (12). The study aims to investigate some hematological profiles in patients infected with giardiasis.

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Materials and Methods Sixty samples of feces were collected from patients of different ages. General stool examination, using light microscope (Olympus, CH: Japan) examination was applied for fresh feces obtained from patients complaining from abdominal discomfort and diarrhea, attending to Al-Sadder Medical City Al-Hakeem General Hospital and Al- Zahra’a Teaching Hospital between November, 2018 to February, 2019. Blood samples in EDTA tubes were mixed well in a mixture apparatus and then 0.2 ml of blood from each sample was aspirated by the detector (Sysmex, XP 300 Japan). When the assay was completed, the results were analyzed automatically by the computer and displayed on the monitor and printed, to estimate WBCs count, RBCs, PCV, Hb., MCHC, MCH and MCV. Thirty blood samples were collected from patients from primary health centers with no history of infection with giardiasis and who were apparently healthy by physical examination.

Results

White Blood Cell Count (WBCs) Cell Count White Blood

Patients

Figure (1): The relationship between white blood cells and infection with Giardia lamblia. Figure (1) shows a comparison between mean level of WBCs of infected patients with Giardia lamblia and the control group, it shows a significant decrease (p<0.05) of infected patients (7.543 ± 0.20 × 103/µL) as compared with control group (4.982 ± 0.14 × 103/µL).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Hemoglobin (Hb.) Hemoglobin

Figure (2): The relationship between hemoglobin level and infection with Giardia lamblia. Figure (2) shows a comparison between mean level of Hb of infected patients with Giardia lamblia and the control group, it shows a significant decrease (p<0.05) of infected patients (9.23 ± 0.8 g/dL) as compared with control group (13.2 ± 0.30 g/dL).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Mean Corpuscular Hemoglobin Concentration (MCHC) Concentration Hemoglobin Corpuscular Mean

Patients

Figure (3): The relationship between MCHC level and infection with Giardia lamblia. Figure (3) shows a comparison between mean level of MCHC of infected patients with Giardia lamblia and the control group, it shows a significant increase (p<0.05) of infected patients (23.11 ± 0.83 g/dL) as compared with control group (29.76 ± 2.76 g/dL).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Mean Corpuscular Hemoglobin (MCH) Corpuscular Hemoglobin Mean

Control Patients

Figure (4): The relationship between mean level of MCH and infection with Giardia lamblia. Figure (4) shows a comparison between mean level of MCH of infected patients with Giardia lamblia and the control group, it shows a significant decrease (p<0.05) of infected patients (24.51 ± 0.36 pg) as compared with control group (51.95 ± 0.24 pg).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Mean Corpuscular Volume Mean (MCV)

Patients

Figure (5): The relationship between MCV level and infection with Giardia lamblia. Figure (5) shows a comparison between mean level of MCV of infected patients with Giardia lamblia and the control group, it shows a significant decrease (p<0.05) of infected patients (72.1 ± 0.82 fL) as compared with control group (83.92 ± 0.26 fL).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

acked Cell (PCV) Volume acked P

Patients

Figure (6): The relationship between PCV level and infection with Giardia lamblia. Figure(6) shows a comparison between mean level of PCV of infected patients with Giardia lamblia and the control group, it shows a significant decrease (p<0.05) of infected patients (30.89 ± 1.28 %) as compared with control group (36.55 ± 1.53 %).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

Red Blood Cells (RBCs) Blood Red

Patients

Figure (7): The relationship between RBCs level and infection with Giardia lamblia. Figure (7) shows a comparison between mean level of RBCs of infected patients with Giardia lamblia and the control group, it shows a significant decrease (p<0.05) of infected patients (4.21 ± 0.35 × 106 / mm3) as compared with control group (5.87 ± 0.25 × 106 / mm3).

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

)

s Platelets (PLT Platelets

Patients

Figure (8): The relationship between Platelets level and infection with Giardia lamblia. Figure (8) shows a comparison between mean level of Platelets of infected patients with Giardia lamblia and the control group, it shows a significant increase (p<0.05) of infected patients (310.12 ± 62.2 × 103 / µL) as compared with control group (309.01 ± 56.8 × 103 / µL).

Discussion Giardia lamblia is one of the intestinal parasites that live in the small intestines of humans causing a number of changes including physiological and hematological changes (13). The results showed a significant decrease in RBCs, Hb and PCV (p<0.05) in patients with giardiasis compared to the control group. These criteria are based on a dense coating flagellates on the intestinal epithelium that damages microvilli and interferes with absorption of fat and other nutrients which probably triggers the onset of disease (14). Some patients had subnormal values of certain parameters, particularly serum vitamin B12 and vitamin B12 absorption, fat, and D- xylose. Giardiasis infection is marked by the hypoproteinema with hypogammaglobulinemia, folic acid and fat-soluble architecture of intestinal villi (15). In children giardiasis may be associated with and contribute to protein energy malnutrition (16). Malabsorption syndrome with malabsorption of fat, folic acid and D-xylose occur in the severely affected, and those become weak and anemic (17). The

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Al-Kufa University Journal for Biology / VOL.12 / NO.1 / Year: 2020 Print ISSN: 2073-8854 Online ISSN: 2311-6544

study has also showed a decrease in the concentration of MCV, MCH and MCHC. The reason is that these criteria are based on RBCs, concentration of Hb. and PCV. The number of platelets showed a significant increase (P<0.05) in patients with giardiasis. Platelets play an important role in mechanical defense against microorganisms, including parasites especially Giardia lambelia which cause an increase in platelets (18). In conclusion, giardiasis include mechanical irritation of intestinal mucosa with shortening of villi inflammatory foci. Malabsorption syndrome may occur in heavy infection which can lead to anemia.

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