The utility of a three part differential hematology analyzer with CRP for assessing malaria

Abstract BackgroundHematology analyzers display abnormal hematology parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining CRP with hematology parameters to obtain further information about the malaria infection.MethodsThe present study shows the results of a retrospective study involving comparison of raw instrument data from a three part differential hematology analyzer with CRP measurement and corresponding microscopic findings of samples obtained during the monsoon season of years 2018 and 2019 in Mumbai, India. Mann-Whitney U and Krustal-Wallis tests were applied for obtaining statistical significance of hematology parameters and CRP among P. vivax, P. falciparum, dengue and negative samples. ResultsThe study considers 1008 non-malaria febrile cases, 209 P. vivax, 31 P. falciparum positive malaria samples, five cases of mixed species malaria infection, and three co-infection of malaria and dengue. Median values of WBCs, PLTs, PCT and %LYM were lower in malaria and dengue samples compared to negative ones with statistical difference (p < 0.05). Contrary, medians of MCHC, MPV, PDW, and %MON were higher than negative samples. The greatest difference in the analyzer results of malaria and dengue cases was observed in between their medians of CRP levels, which is evidenced by the values of the first quartiles of P. vivax and P. falciparum cases, and the third quartile of dengue cases being 8.6 and 10.4 mg/L, respectively.The parameters with a statistical difference for different levels of parasitemia were WBC, PLT, %MON and CRP. An interfering abnormal peak was observed in the white blood cell histogram, below 37 fl, in malaria infected samples, especially in P. vivax cases, where the height of that peak showed a strong correlation with red blood cells infected predominantly with larger parasitic forms.ConclusionsA three differential part hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered.