23Introduction 24 Malaria and sickle cell disease (SCD) co-morbidity have previously been reported in Ghana. 25 However, there is paucity of data on haematological profiles and oxidative stress in co-26 morbidity states. This study identified novel inflammatory biomarkers associated with malaria 27 in SCD and analyzed the levels of 8-iso-prostaglandin F2α oxidative stress biomarker in malaria-28 SCD co-morbidity in Ghanaian patients. 29 Methods 30 Blood (5ml) was collected from malaria patients into K 3 -EDTA tube. Malaria parasites speciation 31 and quantification were then done according WHO guidelines. All eligible samples were assayed 32 for haematological profile, sickle cell phenotyping, infectious markers (hepatitis B, hepatitis C, 33 syphilis and HIV 1&2) and plasma levels of 8-epi-prostaglandin F2α. .
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Results
36Prevalence of malaria in SCD (malaria-SCD) was 13.4% (45/335). Male: female ratio was 0.8:1 37 (X 2 =1.43, p=0.231). Mean ages for malaria in normal haemoglobin type (malaria-HbAA) and 38 malaria-SCD were 12.79±4.91 and 11.56±3.65 years respectively (p=0.048). Geometric mean of 39 parasite density was higher in malaria-HbAA (20394 parasites/µl vs. 9990 parasites/µl, p=0.001) 40 whilst mean body temperature was higher in malaria-SCD (39.0±0.87°C vs. 37.9±1.15°C, 41 p=0.001). Mean leukocytes, lymphocytes, eosinophils, monocytes, platelets and platelet indices 42 values were significantly elevated in malaria-SCD. Significant reduction in RBC and RBC indices 3 43 in malaria-SCD were also observed. Eosinophils-to-basophils ratio (EBR) and monocytes-to-44 basophils ratio (MBR) were novel cellular inflammatory biomarkers which could predict malaria 45 in SCD. The sensitivities of cut-off values of EBR>14, MBR>22 and combined use of EBR>14 and 46 MBR>22 were 79.55%, 84.09% and 91.11% respectively. Mean 8-iso-prostaglandin F2α was 47 338.1pg/ml in malaria-HbAA and 643.8pg/ml in malaria-SCD (p=0.001). 8-iso-prostaglandin F2α 48 correlated with parasite density (r=0.787, p=0.001), temperature (r=0.566, p=0.001) and 49 leucocytes (r=0.573, p=0.001) and negatively correlated with RBC (r=-0.476, p=0.003), 50 haemoglobin (r=-0.851, p=0.001) and haematocrit (r=-0.735, p=0.001). 51 52 Conclusion 53 Plasmodium falciparum parasitaemia increases oxidative damage and causes derangement 54 haematological parameters. Cut of values of EBR>14 and MBR>22 could predict malaria in SCD. 55 Keywords: 8-epi-prostaglandin F2α, oxidative stress, haematological profile, malaria-SCD co-56 morbidity, eosinophils-to-basophils ratio, monocytes-to-basophils ratio 57 58 59 4 63 as level of malaria endemicity, presence of haemoglobinopathies, nutritional status and level of 64 malaria immunity [5, 6]. Malaria is meso-endemic in Ghana with recent nationwide prevalence 65 of 43.4% [7]. Sickle cell disease (SCD) resulting from two haemoglobin S (HbS) haplotypes 66 (HbSS) and heterozygote sickle cell phenotype resulting from one HbS haplotype and one 67 haemoglobin C (HbC) haplotype (HbSC) is also prevalent in Ghana [...
