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The pathophysiology of severe anemia in Zanzibari children The effect of vitamin A and antimalarial treatment

The pathophysiology of severe anemia in Zanzibari children The effect of vitamin A and antimalarial treatment

FASEB Journal 18(4-5): Abst 358 18

Severe anemia (SA) in east African children is prevalent and multifactorial. We aimed to elucidate the pathophysiology of SA (hemoglobin (Hb) < 70 g/L) in Zanzibari children using a hematological model that uses Hb, erythropoietin (EPO), and transferrin receptor (TfR) to classify anemia into 3 types: hemolysis (Type 1), marrow hypoproliferation (Type 2) and defective EPO production (Type 3). A 2nd aim was to measure 72-h effects of sulfadoxine/pyramethamine (SP, an antimalarial) and vitamin A (VA) on these indicators. We hypothesized that VA would stimulate EPO secretion. 180 SA children were identified in a community-based survey. Mean (SD) age was 17 (7) mo, Hb 63 (5) g/L, and CRP 228 (19) ng/ml. Geom. mean EPO was 261 mIU/ml and TfR 19 mg/L. 7 had Type 1 anemia, 151 had Type 2 and 22 had Type 3. Type 2 had lower Hb (p=.016), higher CRP (p=.061) and more malaria (p=.015) than Type 1 and Type 3. All children were treated with VA (100,000 or 200,000 IU based on age), SP, iron, and B-vitamins, but for the first 72 h, they were randomly assigned to only VA or SP. At 72 h, VA decreased EPO (-85 mIU/ml; p=.010), serum ferritin (-18 ug/L; p=.042) and CRP (-96 ng/ml; p=.011). SP decreased CRP (-105 ng/ml, p=.001) and malaria parasite density (-7901 parasites/(l; p=.001). In summary, marrow hypoproliferation was the predominant mechanism of SA. VA and SP both rapidly reduced inflammation, and VA also decreased EPO secretion. Funded by ILSI, NA.

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