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Kho S, Siregar NC, Qotrunnada L, Fricot A, Sissoko A, Shanti PAI, Candrawati F, Kambuaya NN, Rini H, Andries B, Hardy D, Margyaningsih NI, Fadllan F, Rahmayenti DA, Puspitasari AM, Aisah AR, Leonardo L, Yayang BTG, Margayani DS, Prayoga P, Trianty L, Kenangalem E, Price RN, Yeo TW, Minigo G, Noviyanti R, Poespoprodjo JR, Anstey NM, Buffet PA. Retention of uninfected red blood cells causing congestive splenomegaly is the major mechanism of anemia in malaria. Am J Hematol 2024; 99:223-235. [PMID: 38009287 PMCID: PMC10952982 DOI: 10.1002/ajh.27152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/28/2023]
Abstract
Splenomegaly frequently occurs in patients with Plasmodium falciparum (Pf) or P. vivax (Pv) malarial anemia, but mechanisms underlying this co-occurrence are unclear. In malaria-endemic Papua, Indonesia, we prospectively analyzed red blood cell (RBC) concentrations in the spleen and spleen-mimetic retention in 37 subjects splenectomized for trauma or hyperreactive splenomegaly, most of whom were infected with Plasmodium. Splenomegaly (median 357 g [range: 80-1918 g]) was correlated positively with the proportion of red-pulp on histological sections (median 88.1% [range: 74%-99.4%]; r = .59, p = .0003) and correlated negatively with the proportion of white-pulp (median 8.3% [range: 0.4%-22.9%]; r = -.50, p = .002). The number of RBC per microscopic field (>95% uninfected) was correlated positively with spleen weight in both Pf-infected (r = .73; p = .017) and Pv-infected spleens (r = .94; p = .006). The median estimated proportion of total-body RBCs retained in Pf-infected spleens was 8.2% (range: 1.0%-33.6%), significantly higher than in Pv-infected (2.6% [range: 0.6%-23.8%]; p = .015) and PCR-negative subjects (2.5% [range: 1.0%-3.3%]; p = .006). Retained RBCs accounted for over half of circulating RBC loss seen in Pf infections. The proportion of total-body RBC retained in Pf- and Pv-infected spleens correlated negatively with hemoglobin concentrations (r = -.56, p = .0003), hematocrit (r = -.58, p = .0002), and circulating RBC counts (r = -.56, p = .0003). Splenic CD71-positive reticulocyte concentrations correlated with spleen weight in Pf (r = 1.0; p = .003). Retention rates of peripheral and splenic RBCs were correlated negatively with circulating RBC counts (r = -.69, p = .07 and r = -.83, p = .008, respectively). In conclusion, retention of mostly uninfected RBC in the spleen, leading to marked congestion of the red-pulp, was associated with splenomegaly and is the major mechanism of anemia in subjects infected with Plasmodium, particularly Pf.
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Affiliation(s)
- Steven Kho
- Global and Tropical Health DivisionMenzies School of Health Research and Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Nurjati C. Siregar
- Eijkman Institute for Molecular BiologyJakartaIndonesia
- Department of Anatomical PathologyRumah Sakit Cipto Mangunkusumo and Universitas IndonesiaJakartaIndonesia
| | | | | | | | | | - Freis Candrawati
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Noy N. Kambuaya
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Hasrini Rini
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Benediktus Andries
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - David Hardy
- Institut PasteurExperimental Neuropathology UnitParisFrance
| | | | | | | | | | | | - Leo Leonardo
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Bagus T. G. Yayang
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Dewi S. Margayani
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Pak Prayoga
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
| | - Leily Trianty
- Eijkman Institute for Molecular BiologyJakartaIndonesia
| | - Enny Kenangalem
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
- Rumah Sakit Umum Daerah Kabupaten MimikaTimikaIndonesia
| | - Ric N. Price
- Global and Tropical Health DivisionMenzies School of Health Research and Charles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Tsin W. Yeo
- Lee Kong Chian School of MedicineNanyang Technology UniversitySingaporeSingapore
| | - Gabriela Minigo
- Global and Tropical Health DivisionMenzies School of Health Research and Charles Darwin UniversityDarwinNorthern TerritoryAustralia
| | | | - Jeanne R. Poespoprodjo
- Timika Malaria Research ProgramPapuan Health and Community Development FoundationTimikaIndonesia
- Rumah Sakit Umum Daerah Kabupaten MimikaTimikaIndonesia
- Department of PediatricsUniversity of Gadjah MadaYogyakartaIndonesia
| | - Nicholas M. Anstey
- Global and Tropical Health DivisionMenzies School of Health Research and Charles Darwin UniversityDarwinNorthern TerritoryAustralia
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Kambuaya NN, Rini H, Shanti PAI, Alexander K, Candrawati F, Prayoga P, Leonardo L, Margayani DS, Yayang BTG, Kenangalem E, Buffet PA, Anstey NM, Poespoprodjo JR, Kho S. Case Report: Severe Plasmodium vivax Malaria after Splenectomy. Am J Trop Med Hyg 2023; 109:284-287. [PMID: 37339765 PMCID: PMC10397454 DOI: 10.4269/ajtmh.23-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 06/22/2023] Open
Abstract
Severe malaria after splenectomy has been reported with infections with Plasmodium falciparum, Plasmodium knowlesi, and Plasmodium malariae, but is less well-characterized with Plasmodium vivax. We describe a case of severe P. vivax malaria with hypotension, prostration, and acute kidney injury occurring 2 months after splenectomy in Papua, Indonesia. The patient was treated successfully with intravenous artesunate.
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Affiliation(s)
- Noy Norman Kambuaya
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Hasrini Rini
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | | | - King Alexander
- Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
| | - Freis Candrawati
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Pak Prayoga
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Leo Leonardo
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Dewi Sri Margayani
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Bagus Tesa Gina Yayang
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
- Department of Pediatrics, Gadjah Mada University, Yogyakarta, Indonesia
| | - Steven Kho
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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