Sixty consecutive patients of
Plasmodium falciparum malaria with hepatic and renal dysfunction (Group A) and twenty consecutive cases of uncomplicated
falciparum malaria (Group B) were studied. Patients with past history of
alcoholism,
jaundice,
chronic renal failure,
bleeding diathesis or coagulopathy were excluded from the study. Laboratory investigations done were liver and renal function tests, complete blood count and coagulation profile. The data collected was analysed to inter - correlate parameters of hepatic, renal and hemorrheological dysfunction.
RESULTS: In Group A, all had rigor and chill,
icterus while 57% had
oliguria and
hepatomegaly, 37%
splenomegaly, with less than 2% having overt
bleeding diathesis. On evaluation, in Group A, 57% had
acute renal failure, mean value of
bilirubin was 13.91 (+/- 12.53) mg/dL, ALT 76.92 (+/- 37.48) IU/ml, AST 135.32 (+/- 97.33) IU/ml, mean PT was 13.03 (+/- 2.22) seconds, mean aPTT was 31.69 +/- 6.76 seconds,
FDP by
D-dimer was raised in 53% and LDH was raised in 78% respectively. In Group B mean PT was 11.93 (+/- 1.51) seconds, mean APTT was 29.39 +/- 2.89 seconds and
FDP by
D-dimer was raised in 30% respectively.
Thrombocytopenia was seen in 26% cases in Group A and 15% cases in Group B. On analysis, in Group B, there was statistically significant negative correlation of total platelet count with serum AST (p = .010) and serum ALT (p = .036), serum ALP with BT (p = .036), but positively with CT (p = .006) and aPTT (p = .036). In Group A, serum
bilirubin was found to have significant negative correlation with haemoglobin (p = .019),positive correlation with aPTT (p = .037),
urea (p = .000) and serum
creatinine (p = .000), serum ALP Positively with serum
urea (p = .025) and serum
creatinine (p = .037), serum
urea negatively with haemoglobin(p = .015), so also did serum
creatinine (p = .025),prothrombin time positively with serum
urea(p = 0.037) and serum
creatinine (p = 0.013), serum
FDP positively with serum
urea (p = 0.038) and serum
creatinine (p = 0.022), bleeding time positively with serum AST(p = .002).
CONCLUSION: Despite less than 2% of patients in Group A having clinically overt
bleeding diathesis, raised
FDP (53%), prolonged aPTT (67%), low total platelet count (26%) and
anemia (87%) were found in a significant number of patients, suggesting subclinical
DIC. Therefore patients with
Plasmodium falciparum malaria have high incidence of subclinical haemorrheological disorders which do not amount to overt
DIC but adversely affect renal function contributing to
acute renal failure.