MEDizzy - An 8 years old child was admitted with high fever for 5

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Combined Hematology II

An 8 years old child was admitted with high fever for 5 days, jaundice and mild splenomegaly. The work up for hemolysis revealed mildly increased osmotic fragility and mildly positive Coombs test. The patient should be evaluated for:

ExplanationC. The patient should be evaluated for malaria in view of high grade fever. His peripheral blood film should be screened for malarial parasite. Anemia is the most prominent hematological manifestation of malarial infection. It is mostly seen with Plasmodium falciparum, because it invades erythrocytes of all ages whereas P. vivax and P. ovale invade only reticulocytes and P. malariae affects only mature cells. Cellular disruption and hemoglobin digestion lead to hemolysis seen characteristically seen in heavy parasitemia. Parasitized cells have an increased osmotic facility and decreased deformability, causing their sequestration and destruction within the spleen, which often becomes massively enlarged. The malarial antigens may also attach to non-parasitized red cells to give rise to a positive direct Coombs test and hemolysis via a complement - mediated immune response. Acute intravascular hemolysis with hemoglobinuria, often leading to renal failure (called blackwater fever), occurs rarely in P. falciparum infection. So, multiple mechanisms including autoimmune mechanisms, splenic sequestration, DIC and ADP release from damaged red cells leading to platelet activation and consumption, may occur in malaria and may complicate the picture. This child has all these manifestations due to multiple factors generating from malarial infection.