What Is the Relationship between Haptoglobin, Malaria, and Anaemia?

Abstract

In malaria-endemic countries of Africa, anaemia is very common in pregnant women and in children under five. Although anaemia is multifactorial—causative factors include iron deficiency and other nutritional deficiencies, helminth infection, and HIV—malaria is clearly an extremely important factor. Over half of malaria-related deaths are attributed to severe malaria anaemia (which is defined as malaria parasitaemia and a haemoglobin (Hb) concentration less than 50 g/l) [1]. Several antimalarial interventions have been shown to prevent anaemia, including insecticide-treated nets, residual spraying, malaria chemoprophylaxis, and, more recently, intermittent presumptive treatment of infants (i. e., antimalarials coadministered with childhood immunization). Insecticide-treated nets have been shown to decrease all-cause mortality [2]. The pathogenesis of malaria anaemia remains incompletely understood. Dyserythropoiesis (disordered red cell development, which is, at least in part, due to inflammatory cytokines acting on erythroid precursors), intravascular haemolysis of infected red cells, and destruction of both parasitized and uninfected erythrocytes by splenic macrophages are all important [3,4]. Interestingly, it has been estimated that ten or more uninfected erythrocytes may be lost for each infected one [5], presumably because malaria infection alters uninfected erythrocytes. The probable causes of red cell loss include oxidation of band 3 (the anion transporter of the erythrocyte membrane) or membrane lipids, and deposition of IgG, complement, or immune complexes on the erythrocyte surface.