Prevalence of inherited blood disorders and associations with malaria and anemia in Malawian children

McGann, Patrick T.; Williams, Anne; Ellis, Graham; McElhinney, Kathryn E.; Romano, Laurel; Woodall, Julia; Howard, Thad A.; Tegha, Gerald; Krysiak, Robert; Lark, R. Murray; Ander, E. Louise; Mapango, Carine; Ataga, Kenneth I.; Gopal, Satish; Key, Nigel S.; Ware, Russell E.; Suchdev, Parminder S.

doi:10.1182/bloodadvances.2018023069

Cited by 26 publications

(37 citation statements)

References 63 publications

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“…Our study has several limitations. We purposely did not explore factors potentially associated with anaemia that previous studies had shown were uncommon in Malawi, such as haemoglobinopathies and parasitic infections [33,61]. We also did not include an HIV-infected population without severe anaemia against which to compare the prevalence of anaemia aetiologies and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

et al. 2020

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Background Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology are lacking but are needed to improve outcomes. Methods HIV-infected adults with severe (haemoglobin �70g/l) or very severe anaemia (haemoglobin � 50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes and associations with anaemia severity and mortality were explored. Results 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. More than two potential causes for anaemia were present in 94% of the patients including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB infection (41.2%) and unsuppressed HIV infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 17.5 days (IQR 6-55) days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2).

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Section: Discussionmentioning

confidence: 99%

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

et al. 2020

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“…Our study has several limitations. We purposely did not explore factors potentially associated with anaemia that previous studies had shown were uncommon in Malawi, such as haemoglobinopathies and parasitic infections (40, 57). We also did not include an HIV-infected population without severe anaemia against which to compare the prevalence of anaemia aetiologies and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Huibers

Bates

McKew

et al. 2019

Preprint

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Background: Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology is lacking and needed to improve outcomes. Methods:HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes of severe anaemia of anaemia and associations with anaemia severity and mortality were explored.Results: 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. Over two potential causes for anaemia were present in 94% of the patients;including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB-infection (41.2%) andunsuppressed HIV-infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 16 days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2). Conclusion: Mortality among severely anaemic HIV-infected adults is strikingly high.Clinicians must be aware of the urgent need for a multifactorial approach, including starting or optimising HIV treatment; considering TB treatment, nutritional support and attention to potential renal impairment. 109HIV-infected patients with anaemia, especially in resource limiting settings, are scarce. 110Only three of our study patients had confirmed bone marrow malignancies. In contrast 111 MDS was common occurring in 27% of our patients (27, 51). 112Renal impairment was a frequent finding among our study patients and has been 113 linked to HIV disease progression, anaemia and poor outcomes in both wealthy and 114 resource limited settings (52-55). Evaluation of renal function is an important component 115 of severe anaemia treatment protocols (30, 53) since it may affect the choice of ART (52,

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“…Although we present limited information on concomitant genetic blood disorder or hemoglobinopathy variants and anemia, a number of studies show the association between anemia and various genetic blood disorders . Among the two countries that assessed genetic variants, more than half of children with anemia had an inherited blood disorder or variant.…”

Section: Discussionmentioning

confidence: 96%

Data needed to respond appropriately to anemia when it is a public health problem

Williams

Addo

Grosse

et al. 2019

Annals of the New York Academy of Sciences

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Although the proportion of anemia amenable to change varies by population, the World Health Organization (WHO) criteria used to describe the public health severity of anemia are based on population prevalences. We describe the importance of measuring iron and other etiologic indicators to better understand what proportion of anemia could be responsive to interventions. We discuss the necessity of measuring inflammation to interpret iron biomarkers and documenting anemia of inflammation. Finally, we suggest assessing nonmodifiable genetic blood disorders associated with anemia. Using aggregated results from the Global Burden of Disease 2016, we compare population prevalence of anemia with years lived with disability (YLD) estimates, and the relative contributions of mild, moderate, and severe anemia to YLD. Anemia prevalences correlated with YLD and the relative proportion of moderate or severe anemia increased with anemia prevalence. However, individual-level survey data revealed irregular patterns between anemia prevalence, the prevalence of moderate or severe anemia, and the prevalence of iron deficiency anemia (IDA). We conclude that although the WHO population prevalence criteria used to describe the public health severity of anemia are important for policymaking, etiologic-specific metrics that take into account IDA and other causes will be necessary for effective anemia control policies.

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Prevalence of inherited blood disorders and associations with malaria and anemia in Malawian children

Cited by 26 publications

References 63 publications

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Data needed to respond appropriately to anemia when it is a public health problem

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