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Severity of anaemia is associated with bone marrow haemozoin in children exposed to P lasmodium falciparum
Author(s) -
Aguilar Ruth,
Moraleda Cinta,
Achtman Ariel H.,
Mayor Alfredo,
Quintó Llorenç,
Cisteró Pau,
Nhabomba Augusto,
Macete Eusebio,
Schofield Louis,
Alonso Pedro L.,
Menéndez Clara
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12716
Subject(s) - ineffective erythropoiesis , bone marrow , medicine , erythropoiesis , malaria , plasmodium falciparum , pathogenesis , ex vivo , anemia , immunology , in vivo , biology , genetics
Summary There are no large‐scale ex vivo studies addressing the contribution of P lasmodium falciparum in the bone marrow to anaemia. The presence of malaria parasites and haemozoin were studied in bone marrows from 290 anaemic children attending a rural hospital in M ozambique. Peripheral blood infections were determined by microscopy and polymerase chain reactions. Bone marrow parasitaemia, haemozoin and dyserythropoiesis were microscopically assessed. Forty‐two percent (123/290) of children had parasites in the bone marrow and 49% (111/226) had haemozoin, overlapping with parasitaemia in 83% (92/111) of cases. Sexual and mature asexual parasites were highly prevalent (62% gametocytes, 71% trophozoites, 23% schizonts) suggesting their sequestration in this tissue. Sixteen percent (19/120) of children without peripheral infection had haemozoin in the bone marrow. Haemozoin in the bone marrow was independently associated with decreased H b concentration ( P = 0·005) and was more common in dyserythropoietic bone marrows ( P = 0·010). The results of this ex vivo study suggest that haemozoin in the bone marrow has a role in the pathogenesis of malarial‐anaemia through ineffective erythropoiesis. This finding may have clinical implications for the development of drugs targeted to prevent and treat malarial‐anaemia.