Volume 87, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A better understanding of the mechanism of anemia associated with infection might provide useful information on how treatment programs are implemented to minimize schistosomiasis-associated morbidity and maximize treatment impact. We used a cross-sectional study with serum samples from 206 Kenyan school children to determine the mechanisms in -associated anemia. Serum ferritin and soluble transferrin receptor levels were measured by using an enzyme-linked immunosorbent assay. Results suggest that -infected persons are more likely (odds ratio = 3.68, 95% confidence interval = 1.33–10.1) to have levels of serum ferritin (> 100 ng/mL) that are associated with anemia of inflammation (AI) than -uninfected children. Our results suggest that AI is the most common form of anemia in infections. In contrast, the mechanism of anemia in -uninfected children was iron deficiency. Moreover, the prevalence of AI in the study participants demonstrated a significant trend with infection intensity ( < 0.001). Our results are consistent with those observed in -associated anemia.


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  1. Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J, , 2006. Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis 6: 411425.[Crossref]
  2. Global Network, 2009. Schistosomiasis Fact Sheet. Available at: http://globalnetwork.org/about-ntds/factsheets. Accessed August 20, 2009.
  3. King CH, Dickman K, Tisch DJ, , 2005. Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet 365: 15611569.[Crossref]
  4. Stephenson L, , 1993. The impact of schistosomiasis on human nutrition. Parasitology 107 (Suppl): S107S123.[Crossref]
  5. Nelson M, , 1996. Anaemia in adolescent girls: effects on cognitive function and activity. Proc Nutr Soc 55: 359367.[Crossref]
  6. Friedman JF, Kanzaria HK, McGarvey ST, , 2005. Human schistosomiasis and anemia: the relationship and potential mechanisms. Trends Parasitol 21: 386392.[Crossref]
  7. United Nations Administrative Committee on Coordination, Standing Committee on Nutrition, 2000. Fourth Report on the World Nutrition Situation: Nutrition throughout the Life Cycle. Available at: http://www.unscn.org/layout/modules/resources/files/rwns4.pdf. Accessed July 20, 2010.
  8. Koukounari A, Estambale BB, Njagi JK, Cundill B, Ajanga A, Crudder C, Otido J, Jukes MC, Clarke SE, Brooker S, , 2008. Relationships between anaemia and parasitic infections in Kenyan schoolchildren: a Bayesian hierarchical modelling approach. Int J Parasitol 38: 16631671.[Crossref]
  9. Tolentino K, Friedman JF, , 2007. An update on anemia in less developed countries. Am J Trop Med Hyg 77: 4451.
  10. Friedman JF, Kanzaria HK, Acosta LP, Langdon GC, Manalo DL, Wu H, Olveda RM, McGarvey ST, Kurtis JD, , 2005. Relationship between Schistosoma japonicum and nutritional status among children and young adults in Leyte, the Philippines. Am J Trop Med Hyg 72: 527533.
  11. Leenstra T, Acosta LP, Langdon GC, Manalo DL, Su L, Olveda RM, McGarvey ST, Kurtis JD, Friedman JF, , 2006. Schistosomiasis japonica, anemia, and iron status in children, adolescents, and young adults in Leyte, Philippines. Am J Clin Nutr 83: 371379.
  12. Kanzaria HK, Acosta LP, Langdon GC, Manalo DL, Olveda RM, McGarvey ST, Kurtis JD, Friedman JF, , 2005. Schistosoma japonicum and occult blood loss in endemic villages in Leyte, the Philippines. Am J Trop Med Hyg 72: 115118.
  13. Weiss G, Goodnough LT, , 2005. Anemia of chronic disease. N Engl J Med 352: 10111023.[Crossref]
  14. Malope BI, MacPhail AP, Alberts M, Hiss DC, , 2001. The ratio of serum transferrin receptor and serum ferritin in the diagnosis of iron status. Br J Haematol 115: 8489.[Crossref]
  15. Punnonen K, Irjala K, Rajamaki A, , 1997. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89: 10521057.
  16. Lee EJ, Oh E, Park Y, Lee HK, Kim BK, , 2002. Soluble transferrin receptor (sTfR), ferritin, and sTfR/log ferritin index in anemic patients with nonhematologic malignancy and chronic inflammation. Clin Chem 48: 11181121.
  17. Suominen P, Punnonen K, Rajamaki A, Irjala K, , 1998. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood 92: 29342939.
  18. Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott MG, , 1998. Clinical utility of soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 44: 4551.
  19. Wish JB, , 2006. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol 1 (Suppl 1): S4S8.[Crossref]
  20. Ferguson BJ, Skikne BS, Simpson KM, Baynes RD, Cook JD, , 1992. Serum transferrin receptor distinguishes the anemia of chronic disease from iron deficiency anemia. J Lab Clin Med 119: 385390.
  21. Ioannou G, Spector J, Scott K, Rockey DC, , 2002. Prospective evaluation of a clinical guideline for the diagnosis and management of iron deficiency anemia. Am J Med 113: 281287.[Crossref]
  22. National Kidney Foundation, 2006. Kidney Dialysis Outcome Quality Initiative (KDOQI) Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 47 (Suppl 3): S11S145.
  23. Brugnara C, , 2003. Iron deficiency and erythropoiesis: new diagnostic approaches. Clin Chem 49: 15731578.[Crossref]
  24. Tsang VC, Tsang KR, Hancock K, Kelly MA, Wilson BC, Maddison SE, , 1983. Schistosoma mansoni adult microsomal antigens, a serologic reagent. I. Systematic fractionation, quantitation, and characterization of antigenic components. J Immunol 130: 13591365.
  25. Tsang VC, Hancock K, Maddison SE, Beatty AL, Moss DM, , 1984. Demonstration of species-specific and cross-reactive components of the adult microsomal antigens from Schistosoma mansoni and S. japonicum (MAMA and JAMA). J Immunol 132: 26072613.
  26. Gwatkin DR, Rustein S, Johnson K, Pande R, Wagstaff A, , 2000. Socio-Economic Differences in Health, Nutrition and Population in Kenya. Washington, DC: HNP/Poverty Thematic Group, The World Bank.
  27. Government of Kenya Ministry of Health Kimathi NA, Micheni JN, Muriithi A, , 2002. Nutritional and haematologic conditions. , eds. Clinical Guidelines for Diagnosis and Treatment of Common Conditions in Kenya. Nairobi, Kenya: The Regal Press Kenya Ltd., 190202.
  28. Nemeth E, Valore EV, Territo M, Schiller G, Lichtenstein A, Ganz T, , 2003. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute phase protein. Blood 101: 24612463.[Crossref]
  29. Ganz T, Olbina G, Girelli D, Nemeth E, Westerman M, , 2008. Immunoassay for human serum hepcidin. Blood 112: 42924297.[Crossref]
  30. Weiss G, , 2002. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev 16: 8796.[Crossref]
  31. Weiss G, , 2002. Iron and immunity: a double-edged sword. Eur J Clin Invest 32 (Suppl 1): 7078.[Crossref]
  32. Means RT, Jr, 2003. Recent developments in the anemia of chronic disease. Curr Hematol Rep 2: 116121.[Crossref]
  33. Cartwright GE, , 1966. The anemia of chronic disorders. Semin Hematol 3: 351375.
  34. Matzner Y, Levy S, Grossowicz N, Izak G, Hershko C, , 1979. Prevalence and causes of anemia in elderly hospitalized patients. Gerontology 25: 113119.[Crossref]
  35. Oppenheimer SJ, Gibson FD, MacFarlane SB, Moody JB, Harrison C, Spencer A, Bunari O, , 1986. Iron supplementation increases prevalence and effects of malaria: report on clinical studies in Papua New Guinea. Trans R Soc Trop Med Hyg 80: 603612.[Crossref]
  36. Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A, Dhingra U, Kabole I, Deb S, Othman MK, Kabole FM, , 2006. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet 367: 133143.[Crossref]
  37. Leenstra T, Coutinho HM, Acosta LP, Langdon GC, Su L, Olveda RM, McGarvey ST, Kurtis JD, Friedman JF, , 2006. Schistosoma japonicum reinfection after praziquantel treatment causes anemia associated with inflammation. Infect Immun 74: 63986407.[Crossref]
  38. Olson CL, Acosta LP, Hochberg NS, Olveda RM, Jiz M, McGarvey ST, Kurtis JD, Bellinger DC, Friedman JF, , 2009. Anemia of inflammation is related to cognitive impairment among children in Leyte, the Philippines. PLoS Negl Trop Dis 10: e533.[Crossref]

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  • Received : 18 Apr 2012
  • Accepted : 06 Aug 2012

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