Scatterplot Variations Seen in Malaria Using Automated Hematological Analyzers: A Series of Ten Cases
Keywords:malaria, blood, diagnosis, analysis
Background: Malaria is a major health problem in India. Complete blood count and peripheral blood smear (PBS) is important for its diagnosis. Inter observer variation makes PBS fallible. Rapid diagnostic tests cannot detect low parasitemia and mixed infections. Scatterplot from automated analyzers have shown variations previously which might be exploited.
Methods: Scatterplot patterns of ten samples of confirmed malaria and 100 control samples were derived and other infections ruled out by culture and serology as a part of descriptive study between July and August 2018. Each malarial scatterplot was compared with the control pattern for abnormalities and their frequency noted.
Results: All the ten samples belonged to Plasmodium vivax species. Abnormalities detected included split in neutrophilic region, eosinophil-neutrophil merge, neutrophil graying, lymphopenia, ghost red blood cells (RBC), eosinophil split, reactive lymphocytes, monocytosis, pseudoeosinophilia, neutrophilic leukocytosis
Conclusion: Variations in scatterplot patterns are seen in malaria and provide clues to the diagnosis of malaria.
2. Nema S, Verma AK, Bharti PK. Strengthening diagnosis is key to eliminating malaria in India.The Lancet Infectious Diseases. 2019;19(12):1277–8.
3. Ohrt C, Purnomo, Sutamihardia MA, Tang D, Kain KC. Impact of microscopy error on estimates of protective efficacy in malaria prevention trials. J Infect Dis. 2002;186: 540–546.
4. Okell LC, Ghani AC, Lyons E, Drakeley CJ. Submicroscopic infection in Plasmodium falciparum-endemic populations: a systematic review and meta-analysis. J Infect Dis 2009; 200: 1509–17.
5. Krishna S, Bharti PK, Chandel HS, Ahmad A, Kumar R, Singh PP, et al. Detection of Mixed Infections with Plasmodium spp. by PCR, India, 2014. Emerg Infect Dis. 2015;21(10):1853–7.
6. Chiodini PL, Bowers K, Jorgensen P, et al. The heat stability of plasmodium lactate dehydrogenase- based and histidine-rich protein 2-based malaria rapid diagnostic tests. Trans R Soc Trop Med Hyg 2007; 101: 331–37
7. Green R, Wachsmann-Hogiu S. Development, history, and future of automated cell counters. Clin Lab Med. 2015;35(1):1–10.
8. Juthani R, Basu D. Use of scatterplot patterns derived from automated haematological analysers in the diagnosis of acute febrile illnesses. J Clin Diagn Res [Internet]. 2020; Available from: http://dx.doi.org/10.7860/jcdr/2020/43171.13491
9. Singh A, Narang V, Sood N, Garg B, Gupta VK. Malaria diagnosis using automated analysers: A boon for hematopathologists in endemic areas. Journal of Clinical and Diagnostic Research: JCDR. 2015; 9(10):EC05-8.
10. Jain M, Gupta S, Jain J, Grover RK. Usefulness of automated cell counter in detection of malaria in a cancer set up-Our experience. Indian J Pathol Microbiol 2012;55:467-73
11. Sharma S, Sethi N, Pujani M, Kushwaha S, Sehgal S. Abnormal WBC scattergram: a clue to the diagnosis of malaria. Hematology. 2013;18(2):101–5.
12. Hill VL, Simpson VZ, Higgins JM, Hu Z, Stevens RA, Metcalf JA, et al. Evaluation of the performance of the sysmex XT-2000i hematology analyzer with whole bloods stored at room temperature. Lab Med. 2009;40(12):709–18.
13. Dhiman S, Veer V, Dev V. Declining transmission of malaria in India: Accelerating towards elimination. In: Towards Malaria Elimination - A Leap Forward. InTech; 2018.
14. Buoro S, Manenti B, Seghezzi M, Moioli V, Bagorria M, Callegaro A, et al. Abnormal scattergrams and cell population data generated by fully automated hematological analyzers: New tools for screening malaria infection? Int J Lab Hematol. 2018;40(3):326–34.
15. Mohapatra S, Samantaray JC, Arulselvi S, Panda J, Munot K, Saxena R. Automated detection of malaria with haematology analyzer Sysmex XE-2100. Indian J Med Sci 2011; 65:26-31.
16. Campuzano-Zuluaga G, Hänscheid T, Grobusch MP. Automated haematology analysis to diagnose Malaria. Malaria Journal 2010, 9:346.
17. Mubeen KH, Devadoss CW, Rangan RA, Gitanjali M, Prasanna S and VP Sunitha. Automated Hematology Analyzers in Diagnosis of Plasmodium vivax Malaria: an Adjunct to Conventional Microscopy. Mediterr J Hematol Infect Dis. 2014 Jun 1; 6(1):e2014034
18. Huh J, Jung J, Yoon H, Chung W. Pseudoeosinophilia associated with malaria infection determined in the Sysmex XE-2100 hematology analyzer. Ann Hematol. 2005;84(6):400–2.
19. Sharma S, Sethi N, Pujani M, Kushwaha S, Sehgal S. Abnormal WBC scattergram: a clue to the diagnosis of malaria. Hematology. 2013;18(2):101–5.
20. Yoo J-H, Song J, Lee K-A, Sun Y-K, Kim Y-A, Park TS, et al. Automated detection of malaria-associated pseudoeosinophilia and abnormal WBC scattergram by the Sysmex XE-2100 hematology analyzer: a clinical study with 1,801 patients and real-time quantitative PCR analysis in vivax malaria-endemic area. Am J Trop Med Hyg. 2010;82(3):412–4.
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