Ali Hassan Abro, Ahmed Ms Abdou, Jawahar L Gangwani, Abdulla M Ustadi, Nadeem J Younis, Hina Seyada Hussaini.
Hematological and biochemical changes in typhoid fever.
Pak J Med Sci Jan ;25(2):166-71.

Objectives: The hematological and biochemical changes due to multi-organ involvement in typhoid fever are not uncommon. The aim of this study was to determine the frequency and severity of the above changes in adult patients admitted to the hospital because of typhoid fever. Methodology: This was a hospital based descriptive study conducted at the Infectious Diseases unit and medical wards at Rashid Hospital Dubai, United Arab Emirates, from March 2005 to February 2008. The study was designed to include demographics, clinical information, hematological and biochemical changes observed in each patient. Only patients whose blood culture yielded Salmonella typhi were included in the study. Full blood count, liver function tests, blood culture, urea, electrolytes, malaria parasite and coagulation profile were performed for all the patients, whereas viral hepatitis serology and ultrasound abdomen were limited to those with disturbed liver function tests. The patients with ALT> 3 times of normal were screened for viral hepatitis (A, B, & C) serology, whereas the patients’ with significant hematological changes were subjected to bone marrow examination. Results: A total of 75 patients were enrolled into the study. The mean age±SD of the patients under the study were 28.4±8.7 years & males outnumbered the females, 81.3% vs. 18.6%. The most common hematological changes observed were; anemia (61.3%), thrombocytopenia (40%), leucocytosis (10.6%) & leucopenia (4%). Whereas, the biochemical changes included; raised alanine aminotransferase (73.3%), aspartate aminotransferase (62.7%), bilirubin (30.6%), alkaline phosphatase (44%), prothrombin time (57.3) and blood urea (12%), but the serum albumin was found to be low in 40%. The patients with raised ALT had high frequency of thrombocytopenia (p <0.04), raised serum bilirubin (p <0.02), alkaline phosphatase (p <0.01) and prothrombin time (p <0.04). Serum ALT was >10-fold of normal levels in 8%, serum bilirubin was >3mg/dl in 10.3% and prothrombin time was 3 sec above the control in 8% patients. All the patients were discharged in good health once hematological and biochemical changes returned to reference range. Conclusion: Typhoid fever causes significant hematological changes as well as hepatic dysfunction. The involvement of liver was associated with high frequency of extrahepatic complications. Despite the high incidence and serious nature of the hematological changes & liver involvement, these changes are transient and respond favorably to the appropriate antimicrobial therapy.

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