Introduction: The detection of malaria by peripheral smear examination is tedious and requires qualified staff. The diagnosis of malaria with flow cytometry-based haematology analyser scattergrams can become a vital diagnostic method and could help detect cases earlier, especially where there is no clinical suspicion. Hence, this study explores the possibilities of diagnosing malaria through hints provided by automated haematology analyser scattergrams. Aim: To record and tabulate the scattergram abnormalities in malaria and assess the usefulness of Sysmex XN 1000 scattergrams in the diagnosis of malaria. Materials and Methods: A total of 1000 samples of malaria patients received at the Central Diagnostic Laboratory, AJ Institute of Medical Sciences, Mangalore, Karnataka, India during the period July 2014 to June 2016 were enrolled for the study. The samples collected in the lavender-topped EDTA vacutainers were analysed by Sysmex XN 1000 and scattergrams obtained were studied for abnormalities associated with malaria. Peripheral smear diagnosis of malaria was considered as the gold standard. The statistical analysis was done by Chi-square test and Fisher's-exact test. Results: P.vivax was the dominant species seen (60.8%). Greying of neutrophil and eosinophil populations was seen in 75% of vivax (p-value=0.019) and 23.2% of falciparum cases. Two eosinophil populations were seen in 71.6% of vivax (p-value 0.001) and 25.8% of falciparum malaria. Overlapping of eosinophil and neutrophil groups were seen in 73.7% of vivax (p-value 0.001). Two neutrophil populations were seen in 65.4% (p-value 0.001) and right shift of RBC ghost area was seen in 64.2% of vivax cases. The most common abnormality was two neutrophil populations: 69.1% in vivax malaria. Conclusion: The study establishes that malarial parasites can cause scattergram abnormalities in automated haematology analysers which can aid in and increase the detection rate of malaria.
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