The Effect of Alterations in Blood Volume on the Anemia and Hypoproteinemia of Human Malaria 1

Abstract

There is general agreement that humans with active malarial infections 4 develop amenia and hyproproteinemia. The anemia is usually considered to be secondary to erythrocyte destruction by the intracellular parasites, but no adequate explanation has been offered for the hypoproteinemia. Since laboratory techniques commonly used measure only the relative amounts of chemical and cellular components of the blood, it cannot be assumed that these relative measurements always reflect fluctuations in the total amounts of these constituents.In order to determine alterations in the total amounts of circulating plasma proteins and red blood cells, this study of the blood volume changes associated with clinically active, untreated malaria was undertaken. Simultaneous determinations of the plasma proteins, plasma bilirubin, and erythrocyte concentrations were made so that the relative and total amounts of these elements might be calculated and compared. METHODS AND MATERIALSNine patients with central nervous system syphilis, but otherwise relatively normal, served as experimental subjects. The group consisted of 5 white and 3 negro males and 1 negro female. Four patients were inoculated by the bites of Anopheles quadrimaculatus infected with Plasmodium vivax (McCoy strain), 1 patient by the intravenous administration of trophozoites of P. vivax (McCoy strain), and 4 patients by the intravenous injection of trophozoites of P. falciparum (Costa strain). These data are summarized in Table I.

Assessment of Volume Depletion in Children with Malaria

“…Studies in adults with uncomplicated or moderate malaria have given conflicting results [23,24,25,26,27]. …”

Erythrocyte sequestration and anemia in severe falciparum malaria. Analysis of acute changes in venous hematocrit using a simple mathematical model.

“…The increase in plasma volume over the first 79 h of treatment predicted by the model was close to that found using radioisotopic methods in group 2 patients. Other authors have found that increases of similar magnitude (28) occur from an already expanded plasma volume (21,29,30) during the first few days of treatment.…”

Severe Malaria: Metabolic Complications

“…Hypotension is rare [59] and measurements of cardiac output [59], circulating volume [81,82] and total body water [83][84][85] are all normal or slightly elevated. Renal failure observed in severe adult malaria is not related to hypovolaemia [59,81,82].…”