title: The role of reduced red cell deformability in the pathogenesis of severe falciparum malaria and its restoration by blood transfusion.
abstract: As reduced red cell deformability (RCD) can contribute to derangement of the microcirculation, a central feature in the pathogenesis of severe malaria, RCD was measured with a laser diffraction technique in 232 consecutive patients with falciparum malaria on the Kenyan coast, of whom 99 had severe disease. RCD on admission (measured as elongation index [EI] at shear stress = 1.7 Pa) was reduced in proportion with severity of disease (fatal outcome: EI = 0.182 (SD = 0.048), survivors from severe disease: EI = 0.217 (SD = 0.043), uncomplicated malaria: EI = 0.249 (SD = 0.030), healthy controls: EI = 0.268 (SD = 0.022). All but 2 survivors with severe malaria and rigid erythrocytes received a blood transfusion restoring RCD. Reduced RCD may contribute to impaired microcirculatory flow and a fatal outcome in falciparum malaria. RCD can be improved by blood transfusion. Since severely reduced RCD has a strong predictive value for mortality, blood transfusion possibly improves disease outcome not only through its beneficial effect on anaemia but also on RCD.
authors.affiliation: Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands. amdondorp@yahoo.com
authors.forename: A M
authors.initials: AM
authors.lastname: Dondorp
authors.forename: M
authors.initials: M
authors.lastname: Nyanoti
authors.forename: P A
authors.initials: PA
authors.lastname: Kager
authors.forename: S
authors.initials: S
authors.lastname: Mithwani
authors.forename: J
authors.initials: J
authors.lastname: Vreeken
authors.forename: K
authors.initials: K
authors.lastname: Marsh
mesh_terms: D000740:Anemia / Q000097:blood / Q000469:parasitology; D001803:Blood Transfusion / Q000379:methods*; D002675:Child, Preschool; D004907:Erythrocyte Deformability / Q000502:physiology*; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood* / Q000209:etiology; D008833:Microcirculation; D016896:Treatment Outcome