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Inflammation is strongly associated with Plasmodium falciparum malaria and predicts erythropoietin, soluble transferrin receptor, and zinc protoporphyrin concentrations in severely anemic Zanzibari preschool children
Author(s) -
Cusick Sarah E,
Tielsch James M,
Ramsan Mahdi,
Jape Jape K,
Sazawal Sunil,
Black Robert E,
Stoltzfus Rebecca J
Publication year - 2008
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.22.1_supplement.873.12
Subject(s) - zinc protoporphyrin , anemia , hemoglobin , medicine , iron deficiency , inflammation , ferritin , erythropoietin , soluble transferrin receptor , parasitemia , erythropoiesis , malaria , immunology , endocrinology , plasmodium falciparum , heme , chemistry , iron status , biochemistry , enzyme
Plasmodium falciparum malaria (Pf) contributes to severe anemia (SA) in African children, and inflammation is likely to be an important mechanism. We investigated whether Pf and inflammation predicted zinc protoporphyrin (ZPP), transferrin receptor (TfR) and erythropoietin (EPO) concentrations in a community‐based sample of 225 SA [hemoglobin (Hb) ≤ 7 g/dL] Zanzibari children (median age 13 m). Mean Hb (6.3 g/dL), ZPP (286 μmol/mol heme), serum ferritin (48 μg/L) and C‐reactive protein (CRP, 23 mg/L) suggested prevalent iron deficiency and severe inflammation. EPO was high (261 mIU/mL, normal 8–18) and appropriate for the degree of anemia. TfR was high (19 mg/L, < 8) but low for the degree of anemia, suggesting dyserythropoiesis. 76% of children had Pf‐positive blood film, which was strongly correlated with CRP (p<0.01). 17% had fever, which was related to Pf (p<0.01) and less strongly to CRP (p=0.03). Increasing CRP quartile was associated with higher EPO (p for trend = 0.02) and lower TfR (p<0.01) and ZPP (p=0.03). Increasing quartile of Pf parasitemia showed trends with EPO, TfR and ZPP that were similar in direction but less significant. In multivariate analysis with ZPP, EPO or TfR as dependent variables, Pf was not significant once CRP was added. In conclusion, inflammation strongly predicted ZPP, EPO and TfR concentrations in SA children in a manner consistent with iron sequestration and blunted bone marrow.