Iron incorporation and post-malaria anaemia.
BACKGROUND
Iron supplementation is employed to treat post-malarial anaemia in environments where iron deficiency is common. Malaria induces an intense inflammatory reaction that stalls reticulo-endothelial macrophagal iron recycling from haemolysed red blood cells and inhibits oral iron absorption, but the magnitude and duration of these effects are unclear.


RESULTS
We examined the red blood cell incorporation of oral administered stable isotopes of iron and compared incorporation between age matched 18 to 36 months old children with either anaemia post-malaria (n = 37) or presumed iron deficiency anaemia alone (n = 36). All children were supplemented for 30 days with 2 mg/kg elemental iron as liquid iron sulphate and administered (57)Fe and (58)Fe on days 1 and 15 of supplementation respectively. (57)Fe and(58)Fe incorporation were significantly reduced (8% vs. 28%: p<0.001 and 14% vs. 26%: p = 0.045) in the malaria vs. non-malaria groups. There was a significantly greater haemoglobin response in the malaria group at both day 15 (p = 0.001) and 30 (p<0.000) with a regression analysis estimated greater change in haemoglobin of 7.2 g/l (s.e. 2.0) and 10.1 g/l (s.e. 2.5) respectively.


CONCLUSIONS
Post-malaria anaemia is associated with a better haemoglobin recovery despite a significant depressant effect on oral iron incorporation which may indicate that early erythropoetic iron need is met by iron recycling rather than oral iron. Supplemental iron administration is of questionable utility within 2 weeks of clinical malaria in children with mild or moderate anaemia.
Doherty
Conor P
CP
Nutrition Program, Keneba Field Station, Medical Research Council, Fajara, The Gambia. conor.doherty@yorkhill.scot.nhs.uk
Cox
Sharon E
SE
Fulford
Antony J
AJ
Austin
Steven
S
Hilmers
David C
DC
Abrams
Steven A
SA
Prentice
Andrew M
AM
D000740:Anemia / Q000097:blood* / Q000209:etiology*; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use*; D019587:Dietary Supplements; D004912:Erythrocytes / Q000378:metabolism*; D005714:Gambia / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood* / Q000627:therapeutic use; D007503:Iron Isotopes / Q000097:blood; D008288:Malaria / Q000150:complications* / Q000453:epidemiology; D018512:Parasitemia / Q000097:blood
D000962:Antimalarials; D006454:Hemoglobins; D007503:Iron Isotopes; D002738:Chloroquine; D007501:Iron