Retention of uninfected red blood cells causing congestive splenomegaly is the major mechanism of anemia in malaria.

Autor: Kho S; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Siregar NC; Eijkman Institute for Molecular Biology, Jakarta, Indonesia.; Department of Anatomical Pathology, Rumah Sakit Cipto Mangunkusumo and Universitas Indonesia, Jakarta, Indonesia., Qotrunnada L; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Fricot A; UMR_S1134, BIGR, Inserm, Université de Paris, Paris, France., Sissoko A; UMR_S1134, BIGR, Inserm, Université de Paris, Paris, France., Shanti PAI; Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Indonesia., Candrawati F; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Kambuaya NN; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Rini H; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Andries B; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Hardy D; Institut Pasteur, Experimental Neuropathology Unit, Paris, France., Margyaningsih NI; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Fadllan F; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Rahmayenti DA; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Puspitasari AM; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Aisah AR; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Leonardo L; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Yayang BTG; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Margayani DS; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Prayoga P; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia., Trianty L; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Kenangalem E; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia.; Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Indonesia., Price RN; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia., Yeo TW; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, Singapore., Minigo G; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia., Noviyanti R; Eijkman Institute for Molecular Biology, Jakarta, Indonesia., Poespoprodjo JR; Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Indonesia.; Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Indonesia.; Department of Pediatrics, University of Gadjah Mada, Yogyakarta, Indonesia., Anstey NM; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia., Buffet PA; UMR_S1134, BIGR, Inserm, Université de Paris, Paris, France.
Jazyk: angličtina
Zdroj: American journal of hematology [Am J Hematol] 2024 Feb; Vol. 99 (2), pp. 223-235. Date of Electronic Publication: 2023 Nov 27.
DOI: 10.1002/ajh.27152
Abstrakt: Splenomegaly frequently occurs in patients with Plasmodium falciparum (Pf) or P. vivax (Pv) malarial anemia, but mechanisms underlying this co-occurrence are unclear. In malaria-endemic Papua, Indonesia, we prospectively analyzed red blood cell (RBC) concentrations in the spleen and spleen-mimetic retention in 37 subjects splenectomized for trauma or hyperreactive splenomegaly, most of whom were infected with Plasmodium. Splenomegaly (median 357 g [range: 80-1918 g]) was correlated positively with the proportion of red-pulp on histological sections (median 88.1% [range: 74%-99.4%]; r = .59, p = .0003) and correlated negatively with the proportion of white-pulp (median 8.3% [range: 0.4%-22.9%]; r = -.50, p = .002). The number of RBC per microscopic field (>95% uninfected) was correlated positively with spleen weight in both Pf-infected (r = .73; p = .017) and Pv-infected spleens (r = .94; p = .006). The median estimated proportion of total-body RBCs retained in Pf-infected spleens was 8.2% (range: 1.0%-33.6%), significantly higher than in Pv-infected (2.6% [range: 0.6%-23.8%]; p = .015) and PCR-negative subjects (2.5% [range: 1.0%-3.3%]; p = .006). Retained RBCs accounted for over half of circulating RBC loss seen in Pf infections. The proportion of total-body RBC retained in Pf- and Pv-infected spleens correlated negatively with hemoglobin concentrations (r = -.56, p = .0003), hematocrit (r = -.58, p = .0002), and circulating RBC counts (r = -.56, p = .0003). Splenic CD71-positive reticulocyte concentrations correlated with spleen weight in Pf (r = 1.0; p = .003). Retention rates of peripheral and splenic RBCs were correlated negatively with circulating RBC counts (r = -.69, p = .07 and r = -.83, p = .008, respectively). In conclusion, retention of mostly uninfected RBC in the spleen, leading to marked congestion of the red-pulp, was associated with splenomegaly and is the major mechanism of anemia in subjects infected with Plasmodium, particularly Pf.
(© 2023 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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