Hematological Changes in Malaria: A Comparative Study

Abstract

Background: Malaria remains an important cause of hematological morbidity in Pakistan, where species distribution and clinical presentation vary across regions and healthcare settings. Routine complete blood count and peripheral smear findings may provide useful supportive information in malaria evaluation, but local species-wise hematological data remain limited. Objective: To describe the spectrum of hematological abnormalities among confirmed malaria cases and compare selected parameters between Plasmodium falciparum and Plasmodium vivax infections. Methods: This comparative cross-sectional study was conducted at Pak-Emirates Military Hospital, Rawalpindi, from April 2022 to March 2024. Clinically suspected malaria patients were screened using peripheral blood smear microscopy and rapid diagnostic testing. Confirmed malaria-positive patients underwent complete blood count assessment, peripheral smear review, and reticulocyte count estimation. Species-wise comparisons were performed between P. falciparum and P. vivax mono-infections using appropriate statistical tests. Results: Among 400 clinically suspected patients, 74 (18.5%) were malaria-positive. P. falciparum was identified in 39 cases (52.7%), P. vivax in 27 (36.5%), and mixed infection in 8 (10.8%). Anemia was present in 64 patients (86.5%), while thrombocytopenia occurred in 53 (71.6%). Relative lymphopenia was more frequent in P. falciparum than P. vivax infection (33.3% vs. 11.1%; p<0.04). Clinically significant bleeding occurred in 3 of 53 thrombocytopenic patients (5.7%). Conclusion: Malaria was associated with frequent anemia, thrombocytopenia, and smear evidence of erythropoietic stress. Relative lymphopenia showed a species-wise association with P. falciparum, but prospective multicenter validation is needed before prognostic interpretation