Ultrasonographic assessment of splenic volume at presentation and after anti-malarial therapy in children with malarial anaemia

Laman, Moses, Aipit, Susan, Bona, Cathy, Siba, Peter M., Robinson, Leanne, Manning, Laurens, and Davis, Timothy M.E. (2015) Ultrasonographic assessment of splenic volume at presentation and after anti-malarial therapy in children with malarial anaemia. Malaria Journal, 14. 219. pp. 1-9.

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Background: Splenic enlargement is a component of the host response to malaria and may also influence the genesis and progression of malarial anaemia. Few cross-sectional and no longitudinal studies have assessed the relationship between splenic volume measured ultrasonographically and haemoglobin concentrations in children with malaria.

Methods: Fifteen Papua New Guinean children with severe malarial anaemia (SMA; haemoglobin <50 g/L) and ten with moderate malarial anaemia (MMA; 51-99 g/L) were recruited. The SMA patients were given intramuscular artemether followed by oral artemisinin combination therapy (ACT), and were transfused one unit of packed cells 0.3-4.0 days post-admission. The MMA patients were treated with ACT. Splenic enlargement (Hackett's grade, subcostal distance and ultrasonographically determined volume) and haemoglobin concentrations were measured on days 0, 1, 2, 3, 7, 14, 28, and 42.

Results: Associations between Hackett's grade, subcostal distance and splenic volume were modest (r(s) <= 0.62, P < 0.001). Baseline splenic volume was not associated with age or haemoglobin ( P >= 0.90). Mean splenic volume had fallen by approximately 50 % at day 14 in children with MMA ( P <= 0.011 vs days 0, 1 and 2), but there was no change in the SMA group ( P >= 0.30). There was no change in haemoglobin in the MMA group during follow-up but a rise in the SMA group to day 7 ( P <= 0.05 vs days 0, 1, 2, and 3) which paralleled the packed cell volume transfused.

Conclusions: Clinical assessment of splenomegaly is imprecise compared with ultrasonography. Serial splenic volumes and haemoglobin concentrations suggest that the spleen does not influence post-treatment haemoglobin, including after transfusion.

Item ID: 42043
Item Type: Article (Research - C1)
ISSN: 1475-2875
Keywords: malaria; plasmodium falciparum; anaemia; splenic volume; children
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© Laman et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Funders: National Health and Medical Research Council of Australia (NHMRC)., Fogarty Foundation, Royal Australian College of Physicians
Projects and Grants: NHMRC 513782, NHMRC 634343
Date Deposited: 08 Dec 2015 18:32
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1108 Medical Microbiology > 110803 Medical Parasitology @ 100%
SEO Codes: 97 EXPANDING KNOWLEDGE > 970111 Expanding Knowledge in the Medical and Health Sciences @ 100%
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