Species-specific hematological derangements and recovery kinetics in Plasmodium vivax and Plasmodium falciparum malaria: a comparative clinical study

Amita R. Thakur; Rekha A. Mahadik; Prakash R. Marathe; Yatindra Kumar

doi:10.18203/2320-6012.ijrms20263527

Authors

Amita R. Thakur Department of Life Sciences and Biotechnology, Chhatrapati Shivaji Maharaj University, Panvel, Maharashtra, India
Rekha A. Mahadik Department of Life Sciences and Biotechnology, Chhatrapati Shivaji Maharaj University, Panvel, Maharashtra, India
Prakash R. Marathe Shree Avishkar Clinical Laboratory, Kamothe, Navi Mumbai, Maharashtra, India
Yatindra Kumar Department of Life Sciences and Biotechnology, Chhatrapati Shivaji Maharaj University, Panvel, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263527

Keywords:

Thrombocytopenia, Recovery kinetics, Plasmodium vivax, Plasmodium falciparum, Hematological abnormalities, Malaria

Abstract

Background: Malaria remains a major public health concern, yet comparative evidence on species-specific hematological alterations and recovery following treatment is limited. This study compared hematological derangements and recovery kinetics in patients with Plasmodium vivax and Plasmodium falciparum malaria.

Methods: A comparative observational study included 100 laboratory confirmed malaria patients (50 P. vivax, 50 P. falciparum). Diagnosis was established by peripheral smear microscopy and rapid diagnostic tests. Hemoglobin, red blood cell count, platelet count, hematocrit, white blood cell count, and red cell indices were evaluated before and after standard antimalarial therapy using an automated hematology analyzer.

Results: P. falciparum infection produced significantly greater reductions in hemoglobin, erythrocyte count, platelet count, and hematocrit than P. vivax (p<0.05). Thrombocytopenia was the most frequent hematological abnormality, whereas white blood cell counts showed no significant interspecies difference. Although hematological parameters improved after treatment in both groups, recovery was consistently faster and more complete in P. vivax, while delayed normalization persisted in P. falciparum.

Conclusions: Malaria species significantly influence both the severity of hematological abnormalities and the pace of recovery. Serial hematological assessment offers a simple, economical, and clinically valuable approach for species-specific risk stratification, treatment monitoring, and prognosis, particularly in resource limited endemic settings.

Metrics

Metrics Loading ...

References

World Health Organization. World malaria report 2024, 2024. Available at: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024. Accessed 01 July 2026.

World Health Organization. Guidelines for malaria, 2023. Available at: https://www.mmv.org/sites/default/files/content/document/WHO-UCN-GMP-2023.01-eng.pdf. Accessed 01 July 2026.

Cowman AF, Healer J, Marapana D, Marsh K. Malaria: Biology and disease. Cell. 2016;167(3):610-624.e15. DOI: https://doi.org/10.1016/j.cell.2016.07.055

Miller LH, Ackerman HC, Su XZ, Wellems TE. Malaria biology and disease pathogenesis: insights for new treatments. Nat Med. 2013;19(2):156-67. DOI: https://doi.org/10.1038/nm.3073

Perkins DJ, Were T, Davenport GC, Kempaiah P, Hittner JB, Ong'echa JM. Severe malarial anemia: innate immunity and pathogenesis. Int J Biol Sci. 2011;7(9):1427-42. DOI: https://doi.org/10.7150/ijbs.7.1427

Douglas NM, Anstey NM, Buffet PA, Poespoprodjo JR. The anaemia of Plasmodium vivax malaria. Malar J. 2012;11:135. DOI: https://doi.org/10.1186/1475-2875-11-135

Kotepui M, Piwkham D, Phunphuech B, Phiwklam N, Chupeerach C, Duangmano S. Effects of malaria parasite density on blood cell parameters. PLoS One. 2015;10(3):e0121057. DOI: https://doi.org/10.1371/journal.pone.0121057

Lacerda MVG, Mourão MPG, Coelho HCC, Santos JB. Thrombocytopenia in malaria: who cares? Mem Inst Oswaldo Cruz. 2011;106(Suppl I):52-63. DOI: https://doi.org/10.1590/S0074-02762011000900007

Maina RN, Walsh D, Gaddy C, Hongo G, Waitumbi J, Otieno L, et al. Impact of Plasmodium falciparum infection on haematological parameters in children living in western Kenya. Malar J. 2010;9(Suppl 3):S4. DOI: https://doi.org/10.1186/1475-2875-9-S3-S4

Erhart LM, Yingyuen K, Chuanak N, Buathong N, Laoboonchai A, Miller RS, et al. Hematologic and clinical indices of malaria in a semi-immune population in western Thailand. Am J Trop Med Hyg. 2004;70(1):8-14. DOI: https://doi.org/10.4269/ajtmh.2004.70.8

Price RN, Tjitra E, Guerra CA, Yeung S, White NJ, Anstey NM. Vivax malaria: neglected and not benign. Am J Trop Med Hyg. 2007;77(Suppl 6):79-87. DOI: https://doi.org/10.4269/ajtmh.2007.77.79

Bain BJ, Bates I, Laffan MA. Dacie and Lewis Practical Haematology. 13th ed. Philadelphia: Elsevier; 2022.

Garcia LS. Diagnostic Medical Parasitology. 6th ed. Washington, DC: ASM Press; 2016. DOI: https://doi.org/10.1128/9781555819002

Clinical and Laboratory Standards Institute. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture. 7th ed. Wayne, PA: CLSI; 2017.

World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. DOI: https://doi.org/10.1001/jama.2013.281053

Kirkwood BR, Sterne JAC. Essential Medical Statistics. 2nd ed. Oxford: Blackwell Science; 2003.

Moody A. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev. 2002;15(1):66-78. DOI: https://doi.org/10.1128/CMR.15.1.66-78.2002

O'Meara WP, Barcus M, Wongsrichanalai C, Muth S, Maguire JD, Jordan RG, et al. Reader technique as a source of variability in determining malaria parasite density by microscopy. Malar J. 2006;5(1):118. DOI: https://doi.org/10.1186/1475-2875-5-118

White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM. Malaria. Lancet. 2014;383(9918):723-35. DOI: https://doi.org/10.1016/S0140-6736(13)60024-0