Abstract
BackgroundSplenic enlargement is a component of the host response to malaria and may also influence the genesis and progression of malarial anaemia. Few cross-sectional and no longitudinal studies have assessed the relationship between splenic volume measured ultrasonographically and haemoglobin concentrations in children with malaria.MethodsFifteen Papua New Guinean children with severe malarial anaemia (SMA; haemoglobin <50 g/L) and ten with moderate malarial anaemia (MMA; 51–99 g/L) were recruited. The SMA patients were given intramuscular artemether followed by oral artemisinin combination therapy (ACT), and were transfused one unit of packed cells 0.3-4.0 days post-admission. The MMA patients were treated with ACT. Splenic enlargement (Hackett’s grade, subcostal distance and ultrasonographically determined volume) and haemoglobin concentrations were measured on days 0, 1, 2, 3, 7, 14, 28, and 42.ResultsAssociations between Hackett’s grade, subcostal distance and splenic volume were modest (rs ≤ 0.62, P <0.001). Baseline splenic volume was not associated with age or haemoglobin (P ≥0.90). Mean splenic volume had fallen by approximately 50 % at day 14 in children with MMA (P ≤0.011 vs days 0, 1 and 2), but there was no change in the SMA group (P ≥0.30). There was no change in haemoglobin in the MMA group during follow-up but a rise in the SMA group to day 7 (P ≤0.05 vs days 0, 1, 2, and 3) which paralleled the packed cell volume transfused.ConclusionsClinical assessment of splenomegaly is imprecise compared with ultrasonography. Serial splenic volumes and haemoglobin concentrations suggest that the spleen does not influence post-treatment haemoglobin, including after transfusion.
Highlights
Splenic enlargement is a component of the host response to malaria and may influence the genesis and progression of malarial anaemia
Animal studies show the pathophysiological importance of splenic enlargement, with explanted and post-mortem spleen sizes associated with the severity of anaemia complicating malaria [11, 12]
Children with severe malaria anaemia (SMA; haemoglobin concentration
Summary
Splenic enlargement is a component of the host response to malaria and may influence the genesis and progression of malarial anaemia. Few cross-sectional and no longitudinal studies have assessed the relationship between splenic volume measured ultrasonographically and haemoglobin concentrations in children with malaria. Animal studies show the pathophysiological importance of splenic enlargement, with explanted and post-mortem spleen sizes associated with the severity of anaemia complicating malaria [11, 12]. In the case of malaria, one small paediatric study showed that spleen size by palpation significantly overestimated the true incidence of splenomegaly as measured by ultrasound [14]. There have, been no studies that have compared serial changes in splenic volume after treatment assessed by ultrasound to both simpler clinical measurements of spleen size and related outcomes such as the development of malarial anaemia. The spleen generally regresses in size within days to weeks after anti-malarial treatment [17], but blood transfusion as part of the management of SMA may promote persistent splenic enlargement which could, in turn, attenuate the benefits of transfusion [18]
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