Malaria exacerbates inflammation‐associated elevation in ferritin and soluble transferrin receptor with only modest effects on iron deficiency and iron deficiency anaemia among rural Zambian children

Abstract

Abstractobjective In 4-to 8-year-old Zambian children (n = 744), we evaluated the effects of adjusting for inflammation (a1-acid glycoprotein >1 g/l), with or without additional adjustment for malaria, on prevalence estimates of iron deficiency (ID) and iron deficiency anaemia (IDA) during low malaria (LowM) and high malaria (HighM) transmission seasons.methods To estimate adjustment factors, children were classified as: (i) reference (malaria negative without inflammation), (ii) inflammation without malaria (I), (iii) malaria without inflammation (M) and (iv) inflammation with malaria (IM). We estimated the unadjusted ID or IDA prevalence, and then adjusted for inflammation alone (ID I or IDA I ) or inflammation and malaria (ID IM or IDA IM ).results Mean ferritin was 38 (reference), 45 (I), 43 (M) and 54 lg/l (IM) in LowM, increasing to 44, 56, 96 and 167 lg/l, respectively, in HighM. Corresponding mean sTfR was 6.4, 6.9, 7.9 and 8.4 mg/l in LowM, increasing to 8.2, 9.2. 8.7 and 9.7 mg/l in HighM. Ferritin-based ID, ID I and ID IM were 7.8%, 8.7% or 9.1%, respectively, in LowM and 4.6%, 10.0% or 11.7%, respectively, in HighM. Corresponding soluble transferrin receptor (sTfR)-based estimates were 27.0%, 24.1% and 19.1%, respectively, in LowM, increasing to 53.6%, 46.5% and 45.3%, respectively, in HighM. Additional adjustment for malaria resulted in a~1-to 2-percentage point change in IDA, depending on biomarker and season.conclusions In this population, malaria substantially increased ferritin and sTfR concentrations, with modest effects on ID and IDA prevalence estimates.

Implication of asymptomatic and clinical Plasmodium falciparum infections on biomarkers of iron status among school-aged children in Malawi

“…Thus, sTfR shows the amount of iron that is available for erythropoiesis and constitutes a biomarker of the functional iron compartment in the body [ 74 ]. The results of this study are in line with the findings reported in Zambia [ 56 ] and Tanzania [ 59 ], where malaria parasitemia was associated with a significant increase in plasma sTfR levels. In both studies, it was reported that malaria substantially increased sTfR concentrations, but with modest effects on ID and IDA, results which are consistent with the current study.…”

“…Serum ferritin adjusted for inflammation using internal regression approach [ 54 ] was used to define the ID (depleted iron stores). Children were classified as having depleted iron stores if their SF concentration was < 15 μg/L [ 55 , 56 ]. Finally, sTfR levels of ≥ 8.3 mg/L were considered elevated and represented a FID in this populations [ 46 , 55 – 57 ].…”

Standardisation and application of a novel multiplex assay for estimating micronutrient status and inflammatory markers in women of Sauria Paharia and Santhal tribes of Jharkhand

“…in populations where malaria is endemic when ferritin and sTfR have been used for estimating prevalence (53) .…”

Prevalence and characteristics of malaria among COVID-19 individuals: A systematic review, meta-analysis, and analysis of case reports

“…Additionally, COVID-19 infected patients have a higher proportion of laboratory alterations than those of co-infected individuals such as CRP, D-dimer, AST, and ALT. Nevertheless, thrombocytopenia, lymphopenia, mild anemia, elevated bilirubin, elevated D-dimer, and elevated ferritin were observed in Plasmodium monoinfected individuals [41][42][43][44]. Therefore, it is not clear whether laboratory parameters could be semi-diagnostic parameters for COVID-19 and Plasmodium co-infected individuals.…”