title: Malaria Diagnosis Using Automated Analysers: A Boon for Hematopathologists in Endemic Areas.
abstract: BACKGROUND
  Haematological abnormalities are common in acute febrile tropical illnesses. Malaria is a major health problem in tropics. In endemic areas especially in the post monsoon season, it is not practical to manually screen all peripheral blood films (PBF) for malarial parasite. Automated analysers offer rapid, sensitive and cost effective screening of all samples.
  
  
  OBJECTIVE
  The study was done to evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive and negative cases. The comparison of other haematological parameters were also studied which could help to identify malaria parasite in peripheral blood smear.
  
  
  METHODS
  The blood samples were analysed using Beckman coulter LH-750. The abnormal scatter grams and additional peaks in WBC histograms were observed diligently & compared with normal controls. Haematological abnormalities were also evaluated.
  
  
  METHODS
  Statistical analysis was done by using software Epi-Info version 7.1.4 freely available from CDC website. Fisher exact test was applied to calculate the p-value and value < 0.05 was considered as significant. Final identification of malarial parasite species was done independently by peripheral blood smear examination by two pathologists.
  
  
  RESULTS
  Of all the 200 cases evaluated abnormal scatter grams were observed in all the cases of malaria while abnormal WBC histogram peaks were noted in 96% cases demonstrating a peak at the threshold of the histogram. The difference between number of slides positive for abnormal WBC scatter gram and abnormal WBC histogram peaks were statistically highly significant (p=0.007). So abnormal WBC scatter gram can better give idea of malarial parasite presence. Of the haematological parameters thrombocytopenia (92% cases) emerged as the strongest predictor of malaria.
  
  
  CONCLUSIONS
  It is recommended for haematopathologists to review the haematological data and the scatter plots on the analyser along with peripheral blood smear examination.
authors.affiliation: Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .
authors.forename: Aminder
authors.initials: A
authors.lastname: Singh
authors.affiliation: Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .
authors.forename: Vikram
authors.initials: V
authors.lastname: Narang
authors.affiliation: Professor and Head, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .
authors.forename: Neena
authors.initials: N
authors.lastname: Sood
authors.affiliation: Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .
authors.forename: Bhavna
authors.initials: B
authors.lastname: Garg
authors.affiliation: Assistant Professor, Department of SPM, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .
authors.forename: Vikram Kumar
authors.initials: VK
authors.lastname: Gupta
keywords: Automation; Histogram; Malarial parasite; Scatter gram