The Importance of Anaemia in Cerebral and Uncomplicated Falciparum Malaria: Role of Complications, Dyserythropoiesis and Iron Sequestration

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Abstract
Ninety-four per cent of 169 patients with cerebral malaria developed anaemia (haematocrit r=−0.33, pr=−0.25, pr=−0.22, pp<0.001) rise in serum iron 96 h after starting antimalarial treatment; the serum ferritin declined slowly over several weeks. Stainable iron was present in all marrows examined and in eight patients the characteristic pattern of the anaemia of chronic disorders was seen. Seventy-three per cent of patients had dyserythropoiesis which was moderate to gross in 36 per cent. Dyserythropoiesis and erythrophagocytosis were often present on admission but sometimes appeared after the parasitaemia had cleared and persisted for at least three weeks into convalescence. These disturbances in iron metabolism and haemopoiesis are not completely explicable by red blood cell parasitisation. They may contribute more to the anaemia than has previously been recognised.