Hematological changes associated with examination stress: Insights from a pilot study among undergraduate allied healthcare students in Tripura

Background: Academic examinations are a well-recognised source of psychological stress that may influence both hemodynamic and hematological parameters. This study aimed to assess the impact of examination stress on psychological states and hematological indices among undergraduate paramedical students. Methods: A total of 120 students aged 18-21 years were evaluated between January and June 2025. The Depression Anxiety Stress Scale-21 (DASS-21) was administered before and during examinations. Hemodynamic parameters (systolic and diastolic blood pressure, pulse rate) and hematological indices (hemoglobin, hematocrit, RBC, WBC, platelet count, and leukocyte differentials) were measured. Data were analyzed using paired t-tests and Pearson’s correlation. Results: DASS-21 scores revealed a marked increase in anxiety, stress, and depression during examinations, with a substantial shift from the “normal” category to moderate and severe levels. Hemodynamically, systolic blood pressure (118.1 ± 2.3 mmHg vs. 124.6 ± 3.3 mmHg), diastolic blood pressure (76.4 ± 3.5 mmHg vs. 81.9 ± 3.2 mmHg), and pulse rate (73 ± 2.5/min vs. 81.9 ± 3.2/min) rose significantly (p < 0.001). Hematological changes included significant reductions in WBC (4.59 ± 1.19 vs. 3.91 ± 1.03 ×10³/mm³), platelets (3.20 ± 0.90 vs. 2.87 ± 0.85 ×10⁵/mm³), lymphocytes, eosinophils, monocytes, and basophils (all p < 0.001). Correlation analysis showed strong associations between stress, anxiety, and depression, with stress also linked to leukocyte variations. Conclusion: Examination stress exerts a measurable effect on psychological well-being, hemodynamic status, and hematological homeostasis in allied healthcare students. These findings underscore the importance of implementing stress-management and support interventions within academic institutions to safeguard student health during high-stakes assessments.