TRANSFERRIN SATURATION AND RECOVERY FROM COMA IN CEREBRAL MALARIA

To determine if the elevated transferrin saturations found in some pat ients with severe malaria are associated with an adverse outcome in ce rebral malaria, we retrospectively measured baseline saturations in st ored serum samples from 81 Zambian children with strictly defined cere bral malaria. The children had been treated with quinine, sulfadoxine- pyrimethamine, and intravenous infusions of either placebo (n = 39) or the iron chelator, desferrioxamine B (n = 42), in a previously report ed trial (Gordeuk et al, N Engl J Med 327:1473, 1992), More than one-t hird of children in both the placebo- and iron chelator-treated groups had transferrin saturations exceeding 43%, which is 3 standard deviat ions above the expected mean for age. Among children receiving quinine and placebo, those with elevated transferrin saturations had a delaye d estimated median time to recover full consciousness (68.2 hours) com pared with those with saturations less than or equal to 43% (25.4 hour s; P = .006). The addition of iron chelation to quinine therapy in chi ldren with high saturations appeared to hasten recovery (P = .046). We conclude that increased transferrin saturations may be associated wit h delayed recovery from coma during standard therapy for cerebral mala ria and that serum iron and total iron binding capacity should be meas ured in future studies. (C) 1995 by The American Society of Hematology .