Hemolytic anemia in falciparum and vivax malarial patients based on serum bilirubin examination

Objective To examine hemolysis in falciparum and vivax malarial patients based on serum bilirubin examination. Methods A cross sectional study was conducted on children younger than 15 years of age who visited public health center in the district of Mandailing Natal with complaints of fever, shivering, pale, jaundice, diarrhea, or headache between April 9 th and April 19 th 2001. Variables recorded were age, gender, body weight, body height, symptoms and signs, anti malarial drugs, and laboratory test results. Thin and thick blood smears were done as diagnostic tools of malaria. Thin blood smear was also performed to deter- mine the level of malaria parasites in blood (parasitemia) and to examine the morphology of red blood cells. Hemolysis was deter- mined by bilirubin examination. Results In P. falciparum malaria, there was a moderate correlation (r=0.68, p<0.0001) between parasitemia and indirect bilirubin con- centration. While in P. vivax malaria, there was only a weak corre- lation (r=0.46, p=0.007) between parasitemia and indirect bilirubin concentration. It was also found that in falciparum malaria, para- sitemia, total and indirect bilirubin concentrations were significantly higher than that in vivax malaria, with p values of 0.009, 0.015 and 0.003, respectively. Conclusion Hemolysis in falciparum malaria is more severe than that in P. vivax malaria, with marked elevation of indirect bilirubin. The elevation of serum bilirubin correlated with parasitemia