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Iron and folate status in Gambian children with malaria
1Department of Haematology, St Mary's Hospital Medical School, London, UK.
Insights
Malaria in Gambian children causes bone marrow changes, not typically iron or folate deficiency. Iron supplementation is recommended for severe anemia after malaria treatment.
Area of Science:
- Hematology
- Pediatric Infectious Diseases
- Nutritional Anemia
Background:
- Malaria is a significant cause of anemia in children, particularly in regions like The Gambia.
- The relationship between malaria, anemia, and nutrient status (iron, folate) in pediatric populations requires further elucidation.
- Bone marrow morphology can be altered by various conditions, including infections and nutritional deficiencies.
Purpose of the Study:
- To evaluate iron and folate status in Gambian children presenting with malaria and anemia.
- To investigate the underlying causes of dyserythropoiesis observed in malarial anemia.
- To determine the necessity of iron supplementation in children with severe anemia and malaria.
Main Methods:
- Assessed iron and folate status in 106 Gambian children with malaria and anemia.
- Examined bone marrow morphology, including red cell folate, iron stores, and specific cell types (megaloblasts, giant metamyelocytes, ring sideroblasts).
- Monitored changes in folate levels post-antimalarial treatment.
Main Results:
- Normal or elevated red cell folate levels were common (75% at presentation, 15% post-treatment).
- Iron deficiency was present in 28% of patients, but not directly linked to malaria or solely responsible for dyserythropoiesis.
- Morphological changes in bone marrow are likely due to malaria-induced marrow dysfunction, not hematinic deficiency.
Conclusions:
- Malarial anemia in Gambian children is characterized by bone marrow morphological changes indicative of disturbed marrow function.
- These changes are not primarily caused by iron or folate deficiency, although iron deficiency is prevalent.
- Iron therapy is recommended for Gambian children with severe anemia following effective malaria treatment.
Abstract:
Iron and folate status were evaluated in a group of 106 Gambian children with malaria and variable degrees of anaemia. In children with malaria, normal or increased levels of red cell folate were found in 75 patients at presentation and in 15 patients 1-2 weeks after treatment with anti-malarials alone, despite the presence of giant metamyelocytes and megaloblasts in the bone marrow in some cases. Twenty-eight per cent of patients were found to have deficient bone marrow iron stores but malaria could not be directly implicated as the cause of this deficiency. Iron deficiency could also not be implicated as the sole cause of dyserythropoiesis in patients with malarial anaemia. Excess storage iron and the presence of ring sideroblasts were found in the bone marrow in some cases. It is concluded that the morphological changes including dyserythropoiesis, occasional megaloblasts, giant metamyelocytes and ring sideroblasts seen in the bone marrows of these children are manifestations of disturbed marrow function in malaria and are not related to haematinic deficiency. Because of the high rate of iron deficiency found in these patients it is recommended that Gambian children with severe anaemia should receive iron therapy after adequate treatment of malaria.
