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Published on: May 16, 2013
Hematologic parameters in pediatric uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa
Piero Olliaro1, Abdoulaye Djimdé, Grant Dorsey
1United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland. olliarop@who.int
Insights
This study reveals that uncomplicated Plasmodium falciparum malaria in young African children causes modest hematologic changes, including decreased hemoglobin and platelets, and altered white blood cell counts. Neutropenia risk increased with follow-up time.
Area of Science:
- Hematology
- Infectious Diseases
- Pediatrics
Background:
- Hematologic alterations in Plasmodium falciparum malaria are not well-documented, especially in young African children.
- Understanding these changes is crucial for managing malaria and its complications.
Purpose of the Study:
- To investigate hematologic changes in young children with uncomplicated malaria.
- To identify factors influencing these hematologic variations.
Main Methods:
- Analysis of hematologic data from 3,044 children under five years old across seven randomized controlled trials.
- Paired analysis comparing day 28 and baseline values in patients without treatment failure.
- Multivariate random effects modeling to identify trends and explanatory variables.
Main Results:
- A modest increase in leukocyte counts (5%) with a significant rise in neutrophils (43%) and a decrease in lymphocytes (-16%).
- Significant decreases in hemoglobin (-13%) and platelets (-49%).
- Increased risk of neutropenia with follow-up time, influenced by age, parasitemia, and treatment type.
Conclusions:
- Plasmodium falciparum malaria induces distinct hematologic changes in young children.
- Hematologic profiles evolve during follow-up, with neutropenia being a notable concern.
- Artemisinin combination therapy may influence the risk of neutropenia.
Abstract:
Hematologic changes in acute and convalescent uncomplicated Plasmodium falciparum malaria have not been well studied, particularly in young children in Africa. Hematologic data were obtained for 3,044 children less than five years of age in seven randomized controlled trials at 14 sites. Using paired analysis between day 28 and baseline in patients without parasitologic failure as a proxy for malaria-induced effects, we found a statistically significant but clinically modest increase in leukocyte counts (5%) resulting from a larger increase in neutrophils (43%) than the decrease in lymphocytes counts (-16%); levels of hemoglobin and platelets decreased (-13% and -49%, respectively). Multivariate random effects analysis showed trends during follow-up (increased levels of hemoglobin, platelets and lymphocytes, and decreased levels of leukocytes and neutrophils) and identified explanatory variables. The risk of neutropenia increased with follow-up time independent of treatment outcome, and was lower with age, higher baseline parasitemia, and artemisinin combination treatment. These analyses provides information on hematologic variations caused by malaria.
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