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To Editor,

When I was working with Dr VH Salaskar at Opera House, I developed a habit of observing some facts in the clinical practice.

Many years ago when the cell counters were introduced in the Pathology setup (I was the first amongst the few to start the cell counter in suburbs), I observed that the platelet counts were low in malarial infestations when done by cell counter but peripheral smears showed adequacy of platelets. The high take off at Y-axis in WBC histogram suggested the platelet aggregation due to some chemicals released by plasmodium species. The same observation I read in Bombay Hospital Journal that I regularly read. Your Tips for family physicians are very useful.

This year i.e. from June 2003 till date, a very short period for conclusion, I am observing the change in the trend of malarial infestation, viz.

1) Patient presents with severe chills and rigors, almost bending and twisting. The rigor is so much that people almost get scared. Any amount of blankets
are of no use.

2) The platelet count is not that low i.e. around 100,000 to 160,000/cmm (previously it used to be 40,000 to 60,000).

3) There is not much of aggregation as evident from Y-axis of WBC histogram.

4) The parasites are very very scanty with occasional ring and schizont forms.

5) The morphology of the parasite doesnot always fit into either Pl. Vivax or Pl. falciparum.

6) Even after starting the treatment with antimalarials, the rigors persist.

7) We get better results on peripheral smears for malarial parasites, if we palpate or press the spleen and liver before blood collection. Sir, these are my observations. Kindly let me know if you have come across the same, since you see more patients than me.

Dr. Mahendra G Kandalkar
Consultant Pathologist, Histopathologist and
Cytopathologist, Goregaon, Mumbai.

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