Mortality Due to Severe Malarial Anemia is Associated with Thrombocytopenia and Mitigated by Restoration of Platelet Counts Following Whole Blood Transfusion: A Retrospective Observational Study

2021 ◽  
Author(s):  
Matthew Michael Ippolito ◽  
Jean-Bertin Bukasa Kabuya ◽  
Manuela Hauser ◽  
Luc K. Kamavu ◽  
Proscovia Miiye Banda ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Observational Study ◽  
Whole Blood ◽  
Retrospective Observational Study ◽  
Severe Malarial Anemia ◽  
Platelet Counts ◽  
Malarial Anemia

scholarly journals 4148 Thrombocytopenia and whole blood transfusion in children with severe falciparum malaria

2020 ◽  
Vol 4 (s1) ◽  
pp. 40-40
Author(s):  
Matthew M. Ippolito ◽  
Jean-Bertin Kabuya ◽  
Manuela Hauser ◽  
Benjamin Kussin-Shoptaw ◽  
Austin Peer ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Falciparum Malaria ◽  
Whole Blood ◽  
Hemoglobin Concentration ◽  
Rank Test ◽  
Clinical Role ◽  
Platelet Recovery ◽  
Severe Malarial Anemia ◽  
Severe Falciparum Malaria ◽  
Malarial Anemia

OBJECTIVES/GOALS: Severe malarial anemia due to Plasmodium falciparum is often accompanied by thrombocytopenia. Treatment includes transfusion of whole blood, which contains erythrocytes, platelets, and other blood components. The objective of the study was to assess the effect of whole blood transfusion on survival in children with severe falciparum malaria and to examine the potential interaction of thrombocytopenia with malaria mortality and transfusion response. METHODS/STUDY POPULATION: We analyzed a retrospective cohort of 842 hospitalized children in Zambia with severe malarial anemia (703 transfused, 139 not transfused due to stock-out or other reason). Severe malarial anemia was defined as a positive rapid diagnostic test or blood smear in combination with an admission hemoglobin concentration ≤5 g/dL. RESULTS/ANTICIPATED RESULTS: Mortality was 13% (94/703) in the transfused group and 24% (34/139) in the non-transfused group. Kaplan-Meier survival estimates stratified by transfusion status and thrombocytopenia (150,000/μL threshold) showed increased mortality in children with thrombocytopenia who did not undergo transfusion, with no differences in mortality among the other transfused and non-transfused groups (log-rank test P = 0.0001). Effect modification analysis by Cox proportional hazards regression adjusted for age, sex, hemoglobin concentration, blood group type, and eosinophilia showed a significant interaction between platelet count and transfusion status (P = 0.028). Children with thrombocytopenia who were transfused and died had little or no post-transfusion increase in platelets, in contrast to those who survived. Freshness of transfused whole blood, construed from expiration dates, correlated with greater platelet recovery and improved survival. DISCUSSION/SIGNIFICANCE OF IMPACT: The role of platelets in malaria pathophysiology is complex and incompletely understood; prior studies describe preferential binding of platelets to parasitized erythrocytes and direct parasitocidal activity, whereas others detailed deleterious effects in malaria involving the central nervous system vasculature. These findings point to a potential clinical role for platelet-directed transfusion strategies to improve survival in children with severe falciparum malaria, which should be further assessed in randomized interventional studies.

scholarly journals 963. Whole Blood Transcriptome Analysis Reveals Differences in Erythropoiesis and Neurologically Relevant Pathways Between Cerebral Malaria and Severe Malarial Anemia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S35-S35
Author(s):  
Srinivas Nallandhighal ◽  
Gregory Park ◽  
Yen-Yi Ho ◽  
Robert Opoka ◽  
Chandy John ◽  
...  
Keyword(s):  
Gene Expression ◽  
Cerebral Malaria ◽  
Severe Malaria ◽  
Whole Blood ◽  
Heme Oxygenase 1 ◽  
Specific Gene ◽  
Severe Malarial Anemia ◽  
Specific Gene Expression ◽  
Blood Transcriptome ◽  
Malarial Anemia

Abstract Background Plasmodium falciparum malaria can rapidly progress to severe disease that can lead to death if left untreated. Severe malaria cases commonly present as severe malarial anemia (SMA), defined in children as hemoglobin (Hb) <5 g/dL with parasitemia, or as cerebral malaria (CM), which manifests as parasitemia with acute neurological deficits and has an inpatient mortality rate of ~20%. The molecular and cellular processes that lead to CM and SMA are unclear. Methods In a cross-sectional study, we compared genome-wide transcription profiles of whole blood obtained from Ugandan children with acute CM (n = 17) or SMA (n = 17) and community children without P. falciparum infection (n = 12) who were enrolled in a parent cohort study of severe malaria. We determined the relationships between gene expression, hematological indices, and plasma biomarkers, including inflammatory cytokines. Results Both CM and SMA demonstrated enrichment of dendritic cell activation, inflammatory/TLR/chemokines, monocyte, and neutrophil modules but depletion of lymphocyte modules. Neurodegenerative disease and neuroinflammation pathways were enriched in CM. Increased Nrf2 pathway gene expression corresponded with increased plasma heme oxygenase-1 and the heme catabolite bilirubin in a manner specific to children with both SMA and sickle cell disease. Reticulocyte-specific gene expression was markedly decreased in CM relative to SMA despite higher Hb levels and appropriate increases in plasma erythropoietin. Viral sensing/interferon regulatory factor (IRF) 2 module (M111) expression and plasma IP-10 levels both negatively correlated with reticulocyte-specific signatures, but only M111 expression independently predicted decreased reticulocyte-specific gene expression after controlling for leukocyte count, Hb level, parasitemia, and clinical syndrome by multiple regression. Conclusion Differences in the blood transcriptome of CM and SMA relate to neurologically relevant pathways and erythropoiesis. Erythropoietic suppression during severe malaria is more pronounced during CM versus SMA and is positively associated with IRF2 blood signatures. Future studies are needed to validate these findings. Disclosures All authors: No reported disclosures.

scholarly journals Post-malarial anemia in Mozambican children treated with quinine or artesunate: A retrospective observational study

2020 ◽  
Vol 96 ◽  
pp. 655-662
Author(s):  
Rosauro Varo ◽  
Llorenç Quintó ◽  
Antonio Sitoe ◽  
Lola Madrid ◽  
Sozinho Acácio ◽  
...  
Keyword(s):  
Observational Study ◽  
Retrospective Observational Study ◽  
Malarial Anemia

scholarly journals Hemolysis Is Associated with Low Reticulocyte Production Index and Predicts Blood Transfusion in Severe Malarial Anemia

PLoS ONE ◽  
2010 ◽  
Vol 5 (4) ◽  
pp. e10038 ◽  
Author(s):  
Rolf Fendel ◽  
Christian Brandts ◽  
Annika Rudat ◽  
Andrea Kreidenweiss ◽  
Claudia Steur ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Production Index ◽  
Severe Malarial Anemia ◽  
Reticulocyte Production ◽  
Malarial Anemia

scholarly journals PERMINTAAN DARAH PERSIAPAN TINDAKAN BEDAH DI RSUP DR. WAHIDIN SUDIROHUSODO

2018 ◽  
Vol 22 (2) ◽  
pp. 133
Author(s):  
Herlinah Herlinah ◽  
Rachmawati Muhiddin ◽  
Mansyur Arif
Keyword(s):  
Blood Transfusion ◽  
Observational Study ◽  
General Hospital ◽  
General Surgery ◽  
Whole Blood ◽  
Blood Products ◽  
Cross Sectional ◽  
Spss Software ◽  
The Difference ◽  
Surgery Department

Surgical procedures frequently need blood transfusion. However, the blood demand is frequently excessive without an appropriateneed analysis. The high percentage of canceled and returned blood indicates the ineffective use of blood transfusion. To know theappropriateness of blood demand for surgery preparation at the Dr. Wahidin Sudirohusodo General Hospital the researchers analyzedhis matter. This study was an observational study with cross sectional approach. The data of the blood demand for surgery preparationwere obtained from the blood bank of the Dr. Wahidin Sudirohusodo General Hospital, Makassar during August up to November 2013.The data were grouped based on the number of blood demand and the quantity of canceled and returned blood, these were then analyzedby SPSS software. The total of samples which were identified was about 1599 with 3829 blood demands. The quantity of canceled bloodwas1915 and the returned blood was 730. The demand of blood products indicated that whole blood was 2340 (61.3%), PRC 1392(36.4%), platelets 83 (2.2%) and FFP 5 (0.1%). The highest blood demand was observed in the General Surgery Department 797(20.9%). The difference between blood demand and the returned blood quantity (for whole blood and PRC) was analyzed statisticallyand indicated a significant result (p=0.000), this meant that there was a mismatch between blood demand number and the returnedblood quantity. This matter could reflect the ineffective use of blood transfusion.

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