Correlation of malaria parasitaemia with peripheral blood monocyte to lymphocyte ratio as indicator of susceptibility to severe malaria in Ghanaian children.

BACKGROUND: Even though malaria is generally on the decline due extensive control and elimination efforts, it still remains a public health problem for over 40% of the world's population. During the course of malaria infection, parasites and red blood cells come under oxidative stress and there is host immune response in an attempt to protect the red blood cells. The frequency of monocytes and lymphocytes in peripheral blood might, therefore, be expected to reflect the state of an individual's immune response to the infection. Circulating monocytes and lymphocytes could therefore serve as an index in relation to malaria parasitaemia. The purpose of this study was to determine whether the relative count of monocytes to lymphocytes in peripheral blood (M:L ratio) can predict parasitaemia and, therefore, the severity of malaria infection. METHODS: Two millilitre of venous blood sample were taken from participants by venisection into anticoagulant tubes. Thick and thin blood films were made and stained with Giemsa and examined for malaria parasites. Whole blood specimen were analysed for full blood count using ABX Pentra 60 C+ automated haematological analyzer. Data was entered into Microsoft Word and analysed using Statistical Package for Social Sciences (SPSS, Version 20.0) and Graphpad prism. Spearman's correlation was used to determine correlation between occurrences of clinical malaria and the monocytes and lymphocytes ratio. Statistical significance was taken as p ≤ 0.05 with 95% confidence interval. RESULTS: The study comprised of 1629 (m = 896; f = 733) children up to 5 years presenting with clinical malaria as cases and 445 (m = 257; f = 188) apparently healthy children as controls. The results indicated that there was a significant positive correlation between the monocytes to lymphocytes ratio and the presence of parasites (p = 0.04) and the level of parasitaemia within the age group of 0-3 years (p = 0.02) and 4-5 years (p = 0.03). CONCLUSIONS: The monocyte to lymphocyte ratio obtained correlated positively with the presence of malaria as well as the level of parasitaemia. The outcome of this work implies that monocyte to lymphocyte ratio can be used to predict the level of parasitaemia and together with other factors, the development of severe malaria.

The relative merits of therapies being developed to tackle inappropriate ('self'-directed) complement activation.

The complement system is an enzyme cascade that helps defend against infection. Many complement proteins occur in serum as inactive enzyme precursors or reside on cell surfaces. Complement components have many biologic functions and their activation can eventually damage the plasma membranes of cells and some bacteria. Although a direct link between complement activation and autoimmune diseases has not been found, there is increasing evidence that complement activation significantly contributes to the pathogenesis of a large number of inflammatory diseases that may have autoimmune linkage. The inhibition of complement may therefore be very important in a variety of autoimmune diseases since their activation may be detrimental to the individual involved. However, a complete and long-term inhibition of complement may have some contra side effects such as increased susceptibility to infection. The site of complement activation will, however, determine the type of inhibitor to be used, its route of application and dosage level. Compared with conventional drugs, complement inhibitors may be the best option for treatment of autoimmune diseases. The review takes a critical look at the relative merits of therapies being developed to tackle inappropriate complement activation that are likely to result in sporadic autoimmune diseases or worsen already existing one. It covers the complement system, general aspects of complement inhibition therapy, therapeutic strategies and examples of complement inhibitors. It concludes by highlighting on the possibility that a better inhibitor of complement activation when found will help provide a formidable treatment for autoimmune diseases as well as preventing one.

Anemia in prospective blood donors deferred by the copper sulphate technique of hemoglobin estimation.

BACKGROUND: Patients who require transfusion as part of their clinical management have the right to expect sufficient blood to be available to meet their needs and to receive the safest blood possible. Donor deferrals (disqualification) lead to loss of precious blood donors and blood units available for transfusion purposes. It is believed that a large majority of donor deferrals are due to temporal and correctable causes such as anemia in developing countries. It is therefore important to determine anemia among donor population to inform decision-making on the type of measures to be taken to reduce deferrals due to anemia. The aim of the study was to determine anemia in prospective blood donors deferred by the copper sulphate technique of hemoglobin estimation. This, to provide information that would help plan a future strategy for donor recruitment and management. METHODS: Three (3) ml of venous blood samples were collected from the study subjects into EDTA anticoagulant tubes. The hemoglobin levels and red cell indices were measured using Sysmex hematology analyser. A thin blood film was prepared and stained using Leishman stain and then observed under the light microscope. RESULTS: The prevalence of anemia among the total deferred patients (538) was 17.1 %. Four different types of anemia were found among the subjects. These were normocytic normochromic (46.74 %), microcytic hypochromic (42.39 %) normocytic hypochromic (8.70 %), and microcytic normochromic anemia (2.17 %). CONCLUSION: The study showed that a significant number of the prospective blood donors deferred for having low hemoglobin by the copper sulphate method turned out to have anemia by the standard method of diagnosis. Prevalence of anemia among apparently healthy blood donors was therefore higher than expected. Measures must therefore be taken to address this in order not to lose potential blood donors due to a correctable and preventable cause such as anemia.