Hemolytic anemia in falciparum and vivax malarial patients based on serum bilirubin examination

Abstract

Objective To examine hemolysis in falciparum and vivax malarial
patients based on serum bilirubin examination.
Methods A cross sectional study was conducted on children
younger than 15 years of age who visited public health center in
the district of Mandailing Natal with complaints of fever, shivering,
pale, jaundice, diarrhea, or headache between April 9 th and April
19 th 2001. Variables recorded were age, gender, body weight, body
height, symptoms and signs, anti malarial drugs, and laboratory
test results. Thin and thick blood smears were done as diagnostic
tools of malaria. Thin blood smear was also performed to deter-
mine the level of malaria parasites in blood (parasitemia) and to
examine the morphology of red blood cells. Hemolysis was deter-
mined by bilirubin examination.
Results In P. falciparum malaria, there was a moderate correlation
(r=0.68, p<0.0001) between parasitemia and indirect bilirubin con-
centration. While in P. vivax malaria, there was only a weak corre-
lation (r=0.46, p=0.007) between parasitemia and indirect bilirubin
concentration. It was also found that in falciparum malaria, para-
sitemia, total and indirect bilirubin concentrations were significantly
higher than that in vivax malaria, with p values of 0.009, 0.015 and
0.003, respectively.
Conclusion Hemolysis in falciparum malaria is more severe than
that in P. vivax malaria, with marked elevation of indirect bilirubin.
The elevation of serum bilirubin correlated with parasitemia