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Open Access Research

Disseminated intravascular coagulation following malaria due to Plasmodium vivax: a thromboelastography-based study

Sarita Mohapatra1*, Jyotish C Samantaray2, Subramaniyan Arulselvi3 and Arnab Ghosh2

Author Affiliations

1 Department of Microbiology, Vardhaman and Mahavir Medical College and Safdarjung Hospital, 5th floor, New Delhi 110029, India

2 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

3 Unit of Laboratory Medicine, JPNA Trauma Centre;, All India Institute of Medical Sciences, New Delhi, India

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Malaria Journal 2013, 12:336  doi:10.1186/1475-2875-12-336

Published: 22 September 2013

Abstract

Background

Disseminated intravascular coagulation (DIC) due to Plasmodium vivax is scarcely reported in comparison to Plasmodium falciparum. In complicated malaria, thrombocytopaenia and haemostatic alterations lead to increased activation of coagulation cascade and fibrinolytic system. Thromboelastography (TEG) is a haemostasis system which measures the viscoelastic strength of blood clot in the coagulation pathway. It detects the initial derangement in clotting cascade involving in platelet interaction and fibrinolysis. Hence, it can document the early changes in coagulation in vitro, and thereby guide the management. The current study was aimed at detection of DIC in patients with P. vivax malaria based on TEG.

Methods

Ethylene diamine tetraacetic acid (EDTA) blood samples from acute febrile patients were tested by microscopy and immunochromatographic test for malaria. A total of 31 confirmed cases of vivax malaria were enrolled for this study. All the samples were tested by thromboelastography and conventional tests parameters for detection of any coagulation derangement.

Results

Of 31, 17 (55%) were classified as complicated and 14/31 (45%) were uncomplicated. Among 23 cases with thrombocytopaenia, non-overt (early stage) DIC was detected in 18 cases by TEG and 17 cases by the conventional methods.

Conclusion

It seems that the burden of DIC in vivax malaria is much higher than the world literature reported. TEG can be utilized as an important tool for early detection of DIC and guiding the management in malaria patients.

Keywords:
Plasmodium vivax; Severe malaria; Disseminated intravascular coagulation; Thromboelastography