DECREASED ERYTHROPOIETIN RESPONSE IN PLASMODIUM-FALCIPARUM MALARIA-ASSOCIATED ANEMIA

One of the most serious manifestations of Plasmodium falciparum malari a is anaemia. Its established causes are increased red cell destructio n and ineffective erythropoiesis. Since proinflammatory cytokines have been shown to suppress the in vitro synthesis of erythropoietin (Epo) , we measured serum immunoreactive Epo in 90 Sudanese patients sufferi ng from malaria. Even in severe cases of anaemia (blood haemoglobin <8 0 g/l, serum Epo levels rarely exceeded 300 U/l. For comparison, serum Epo was increased up to 12,000 U/l in a reference group of Caucasian patients with anaemia not associated with infection. Moreover, the slo pe of the log Epo/haemoglobin regression line was less steep in malari al anaemia, Thus, as documented for other chronic inflammatory disorde rs, there is a relative lack of Epo in malaria-associated anaemia. Tre atment with the antimalarial drug chloroquine may aggravate the defect in Epo production, because chloroquine inhibited Epo synthesis when t ested in cell culture.