Prognostic Significance of Reduced Red Blood Cell Deformability in Severe Falciparum Malaria

Adrianus M. Dondorp Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Brian J. Angus Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Max R. Hardeman Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Kesinee T. Chotivanich Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Kamdrat Silamut Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Ronatrai Ruangveerayuth Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Piet A. Kager Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Nicholas J. White Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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Johan Vreeken Department of Internal Medicine and Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Faculty of Tropical Medicine, Mahidol University, Department of Medicine, Mae Sot Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Amsterdam, The Netherlands

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DOI:
https://doi.org/10.4269/ajtmh.1997.57.507
Volume/Issue:
Volume 57: Issue 5
Page(s):
507–511
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Severe falciparum malaria is associated with microvascular obstruction resulting from sequestration of erythrocytes containing mature stages of the parasite. Since reduced red blood cell deformability (RBC-D) can contribute to impaired microcirculatory flow, RBC-D was measured in 23 patients with severe falciparum malaria (seven of whom subsequently died), 30 patients with uncomplicated malaria, and 17 healthy controls. The RBC-D, measured by ektacytometry, was significantly reduced in severe malaria and was particularly low in all fatal cases. At a low shear stress of 1.7 Pascal (Pa), a red blood cell elongation index less than 0.21 on admission to the hospital predicted fatal outcome with a sensitivity of 100% (confidence interval [CI] = 59–100%) and a specificity of 88% (CI = 61–98%). The reduction in the RBC-D appeared to result mainly from changes in unparasitized erythrocytes. Reduced deformability of unparasitized red blood cells in severe malaria may contribute to impaired microcirculatory flow and a fatal outcome in severe falciparum malaria.

Author Notes

Copyright:
Copyright © 1997 by The American Society of Tropical Medicine and Hygiene 1997
Published Online:
Nov 1997
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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