Fetal Hemoglobin Modifies the Disease Manifestation of Severe Plasmodium Falciparum Malaria in Adult Patients with Sickle Cell Anemia

hemoglobin modifies the disease manifestation of severe Plasmodium falciparum malaria in adult patients with sickle cell anemia. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Sickle cell anemia (SCA) and Plasmodium falciparum malaria are two major public health problems in the state of Odisha, India. The prevalence of sickle cell gene in the western part of Odisha is 13.1%, 1 P. falciparum contributes 23% of cases and 15% of malaria-related deaths in India. Various African studies have shown that, even though SCA protects from P. falciparum infection, the risk of severe illness and death due to malaria is higher. 2,3 Though several factors are responsible for the disease severity in P.falciparum malaria in patients with SCA, it was recently found that fetal hemoglobin (HbF), a physiological hemoglobin usually found higher in patients with SCA had a negative epistatic interaction with HbS during protection against malaria. 4 The role of HbF against P. falciparum malaria in cases with normal hemoglobin genotypes has been widely studied and found to be protective against severe disease manifestation. So it is necessary to investigate this association in the regions with high prevalence of sickle cell gene and high endemicity of P. falciparum malaria. This study aims to find out the effect of HbF level on the clinical manifestation of severe P.falciparum malaria in patients with SCA. Forty-six adult patients with SCA along with severe P. falciparum malaria admitted in the Department of Medicine of this institute were included in this study. The mean age of patients was 25.4±8.8 years (range, 17 to 60 years) with 58.7% (27/46) being males. The hemoglobin variants including HbF was estimated by Cation-Exchange high performance liquid chromatography (CE-HPLC) using Variant II – í µí»½-thalassemia short program (Bio-Rad laboratories, Hercules). The mean % HbF level was found to be 18. 2 ± 4.9 %; ranging from 6.0 to 29.0 %. The severity of malaria was defined by WHO guideline in 2010. 5 The severity due to the malarial infection was defined by the presence of single or multiple complications. Cerebral malaria, severe malarial anemia, jaundice, acute renal failure and/or hepatopathy were considered as the major clinical symptoms of the patients. Among the various clinical symptoms, the incidence of cerebral malaria was 37.0% (17/46) followed by …