Malaria is one of the major health problems in the world. It remains an important cause of very high human morbidity and mortality, especially, among children and pregnant women. It results from the infection of parasites belonging to the genus Plasmodium. Plasmodium falciparum and Plasmodium vivax are the major pathogens responsible for causing human malaria. Approximately 75% of cases are caused by P. falciparum and associated with the mortality rate of approximately 0.5 to 1.0%. Both P. falciparum and P. vivax induce anemia during their erythrocytic stages of infection. Most of the malarial infections are related to some degree of anemia, the severity of which depends upon patient-specific characteristics (e.g., age, innate and acquired resistance, comorbid features, etc.) as well as parasite-specific characteristics (e.g., species, adhesive, and drug-resistant phenotype, etc.). Malarial anemia encompasses reduced production of erythrocytes as well as increased removal of circulating erythrocytes in the bone marrow. Susceptibility to severe malarial anemia is associated with the polymorphisms of the cytokines, which are likely to function by perturbing erythropoiesis. This article reviews the epidemiology, pathophysiology, clinical features, treatment, and various complications occurring due to malarial anemia. The second part of this article also focuses on the effect of malaria during pregnancy. Some significant effects of malaria during pregnancy include spontaneous abortion, preterm delivery, low birthweight, stillbirth, congenital infection, and maternal death. How to cite this article Saxena R, Bhatia A, Midha K, Debnath M, Kaur P. Malaria: A Cause of Anemia and Its Effect on Pregnancy. World J Anemia. 2017;1(2):51-62.
It is the responsibility of the physician to take care of the necessary steps that a blood product is indicated, and the standard practices for the transfusion of the blood is observed. 7 Obstetric conditions linked with the requirement for blood transfusion might cause morbidity and mortality if not fared appropriately. The increasingly important issues in blood transfusion are adverse events associated with transfusion, including potential infection and potential transmission of prions, rising costs, and the possible future problems of availability. The aim of this review is to offer guidance about the appropriate use of blood products that neither compromises the affected woman nor exposes her to unnecessary risk. PHYSIOLOGICAL BASIS OF TRANSFUSIONThe major aim for transfusion of blood and its components is to: • Increase the oxygen-carrying capacity of the blood. • Replacement of clotting factors which are lost, consumed, or not produced. Underneath the normal situations, the delivery of oxygen to the tissues is 1000 mL/min and the oxygen consumption is 200 mL/min. Henceforth, the ratio of oxygen delivery to oxygen consumption is 5:1. In case of patients suffering from anemia, hypoxia, or myocardial failure in whom the utilization is enhanced, and the delivery of oxygen cannot be enhanced, this ratio of 5:1 will drop in the patient consuming up the inherent oxygen reserves. This situation continues until the ratio falls to 2:1 up to which level the patient rests stable. Thus, the reference to transfuse a patient must lay emphasis on compensatory capability of the patient and physiologic parameters and not only on the packed cell volume (PCV) as is the case normally. Transfusion, thus, is only necessary when patients cannot counterbalance for their anemia.When the compensatory mechanisms are normal with a tolerable oxygen delivery, it might not be obligatory to transfuse patients until the PCV drops below 16% (hemoglobin, Hb < 5.3 gm/dL) and in patients with poor compensatory mechanisms may only be advised when the PCV drops below 25% (Hb < 8.3 gm/dL). [8][9][10] Hemoglobin usually ranges between 12 and 18 gm/dL differing on race, age, sex, and medical condition. The capability of bearing the lower concentrations of Hb depends on: • The degree and size of blood loss.• State of tissue perfusion.• Preexisting cardiopulmonary disease.
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