Hematologic Parameters in Pediatric Uncomplicated Plasmodium falciparum Malaria in Sub-Saharan Africa

Abstract

Hematologic changes in acute and convalescent uncomplicated Plasmodium falciparum malaria have not been well studied, particularly in young children in Africa. Hematologic data were obtained for 3,044 children less than five years of age in seven randomized controlled trials at 14 sites. Using paired analysis between day 28 and baseline in patients without parasitologic failure as a proxy for malaria-induced effects, we found a statistically significant but clinically modest increase in leukocyte counts (5%) resulting from a larger increase in neutrophils (43%) than the decrease in lymphocytes counts (–16%); levels of hemoglobin and platelets decreased (–13% and –49%, respectively). Multivariate random effects analysis showed trends during follow-up (increased levels of hemoglobin, platelets and lymphocytes, and decreased levels of leukocytes and neutrophils) and identified explanatory variables. The risk of neutropenia increased with follow-up time independent of treatment outcome, and was lower with age, higher baseline parasitemia, and artemisinin combination treatment. These analyses provides information on hematologic variations caused by malaria.

Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins

“…by guest www.bloodjournal.org From been observed in thousands of uncomplicated malaria cases in both adults and children treated with artemisinin combined therapy. 35,36 Our observations also suggest that the persistent pattern may result from a more complex overlap of mechanisms that comprise those causing the 2 polar rising and PADH patterns (Figures 2 and 4). A monophasic, accelerated clearance of normal or uninfected erythrocytes has been observed in malaria patients in Thailand.…”

Effect of Plasmodium falciparum malaria parasites on haematological parameters in Ghanaian children

“…Perhaps, a more large-scale survey is much more likely to be with little bias for severe malaria. Second, the absence of comparative data on widely reported monocytes and platelets detracts from the strength of this study (Erhart et al 2004;Quintó et al 2006;Olliaro et al 2011). Nevertheless, the strong association of low haemoglobin \11 g/dl in patients with P. falciparum infection, as compared to the others argues for recognition of low haemoglobin as an important predictor of malaria in febrile patients.…”

“…Most workers have looked at patelets, monocytes, haemoglobin, total white blood cell counts, neutrophils and lymphocytes (Erhart et al 2004;Quintó et al 2006;Olliaro et al 2011), and a few have reported on eosinophils and basophils (Maina et al 2010). Irrespective of the measured parameters, low haemoglobin \11 g/dl, low platelets \1.5 9 10 4 lL, high monocytes counts [1.5 9 10 3 lL and their combinations thereof, have had superior predictive capacity for P. falciparum infections in Sub-Sahara Africa (Quintó et al 2006;Oduro et al 2007;Adedapo et al 2007;Olliaro et al Fig. 2 Haemoglobin versus age distribution of (a) P. falciparum infected and (b) non-malaria infected aneamic children with Tricube kernel smooth fit line generated with local polynomial regression at 60 % of points to fit 2011).…”

“…Indeed, it is becoming increasingly clear that many disease pathologies modulate mitochondrial energetics in leucocytes as early warning signs for bioenergetics dysfunction (Guha et al 2006;Dey et al 2009). This opens up the possibility that circulating leukocytes, particularly lymphocytes and neutrophils could serve as biomarkers for oxidative stress, and as an index of inflammation in relation to malaria parasiteamia (Maina et al 2010;Olliaro et al 2011).…”

Analysis of hospital account of malaria cases in a Malawian hospital

“…in the aspects of the current world burden, control and epidemiology (Bell et al, 2005;Socrates, 2015;Olliaro et al, 2011). There are enormous literature resources to understand the clinical, socio-economic and political aspects of this disease.…”