Reversible suppression of bone marrow response to erythropoietin in Plasmodium falciparum malaria

TY - JOUR

T1 - Reversible suppression of bone marrow response to erythropoietin in Plasmodium falciparum malaria

AU - Kurtzhals, J A

AU - Rodrigues, O

AU - Addae, M

AU - Commey, J O

AU - Nkrumah, F K

AU - Hviid, L

N1 - Keywords: Antimalarials; Bone Marrow; Bone Marrow Diseases; Child; Child, Preschool; Chloroquine; Erythropoiesis; Erythropoietin; Hemoglobins; Humans; Malaria, Falciparum

PY - 1997

Y1 - 1997

N2 - To study the importance of bone marrow inhibition in the pathogenesis of malarial anaemia, haematological and parasitological parameters were followed in patients with acute malaria. Three patient categories were studied, severe malarial anaemia (SA), cerebral malaria (CM) and uncomplicated malaria (UM). Red cell distribution width (RDW) was used as a surrogate marker of release of young erythrocytes and reticulocytes. Initially RDW was low in all patients in spite of markedly increased concentrations of erythropoietin (EPO). 3 d after institution of treatment and coinciding with parasite clearance RDW increased dramatically, reaching the highest levels 1-2 weeks later. Although severe anaemia was corrected by blood transfusion during the first 3 d of treatment, the peak RDW correlated significantly with the initial EPO levels. This suggests that Plasmodium falciparum infection causes a rapidly reversible suppression of the bone marrow response to EPO. Furthermore, the inhibition of bone marrow response was a general finding irrespective of initial haemoglobin levels suggesting that the severity of anaemia depends upon the degree of peripheral erythrocyte destruction in patients with suppressed bone marrow response to EPO.

AB - To study the importance of bone marrow inhibition in the pathogenesis of malarial anaemia, haematological and parasitological parameters were followed in patients with acute malaria. Three patient categories were studied, severe malarial anaemia (SA), cerebral malaria (CM) and uncomplicated malaria (UM). Red cell distribution width (RDW) was used as a surrogate marker of release of young erythrocytes and reticulocytes. Initially RDW was low in all patients in spite of markedly increased concentrations of erythropoietin (EPO). 3 d after institution of treatment and coinciding with parasite clearance RDW increased dramatically, reaching the highest levels 1-2 weeks later. Although severe anaemia was corrected by blood transfusion during the first 3 d of treatment, the peak RDW correlated significantly with the initial EPO levels. This suggests that Plasmodium falciparum infection causes a rapidly reversible suppression of the bone marrow response to EPO. Furthermore, the inhibition of bone marrow response was a general finding irrespective of initial haemoglobin levels suggesting that the severity of anaemia depends upon the degree of peripheral erythrocyte destruction in patients with suppressed bone marrow response to EPO.

U2 - 10.1046/j.1365-2141.1997.82654.x

DO - 10.1046/j.1365-2141.1997.82654.x

M3 - Journal article

C2 - 9136961

SN - 0963-1860

VL - 97

SP - 169

EP - 174

JO - British Journal of Haematology, Supplement

JF - British Journal of Haematology, Supplement

IS - 1

ER -