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Open Access Commentary

The pathophysiology of malarial anaemia: where have all the red cells gone?

Oscar K Kai1 and David J Roberts2*

Author Affiliations

1 Wellcome Trust/Kenya Medical Research Institute-Centre for Geographic Medicine Research Coast, Immunology Department, PO Box 230, Kilifi 80108, Kenya

2 National Blood Service – Oxford Centre, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, UK

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BMC Medicine 2008, 6:24  doi:10.1186/1741-7015-6-24

Published: 21 August 2008

Abstract

Malarial anaemia is an enormous public health problem in endemic areas and occurs predominantly in children in the first 3 years of life. Anaemia is due to both a great increase in clearance of uninfected cells and a failure of an adequate bone marrow response. Odhiambo, Stoute and colleagues show how the age distribution of malarial anaemia and the haemolysis of red blood cells may be linked by an age-dependent increase in the capacity of red blood cells to inactivate complement components absorbed or deposited directly on to the surface of the red blood cell. In this commentary, we discuss what has been established about the role of complement deposition on the surface of red blood cells in the pathology of malarial anaemia, how genetic polymorphisms of the complement control proteins influence the outcome of malaria infection and how the findings of Odhiambo, Stoute and colleagues and others shed light on the puzzling age distribution of different syndromes of severe malaria.