Editorial The Anaemia of Malaria

Since red cells are the major target of the malarial parasite and as such are destined for premature destruction, should this not adequately explain the sometimes life-threatening fall in haemoglobin seen in this infection? Such an explanation is obviously inadequate, for the degree of anaemia is often far in excess of that accounted for by the removal of infected cells alone. These factors make the anaemia of malaria both an important clinical complication and a challenging biological problem in one of the most common infections of man. In this issue of the Journal, Phillips, Warrell and co-workers in Thailand have made another important contribution to our clinical understanding of malaria due to Plasmodium falciparum and the aetiology of the anaemia caused by it [1]. Their extensive study including 169 patients with well-defined cerebral malaria has highlighted the frequency of this complication since almost all (94 per cent) of their cerebral cases were anaemic (haematocrit <35 per cent). Furthermore at least 30 per cent required blood transfusion to sustain a haematocrit greater than 21 per cent. Anaemia was most severe in patients with bacterial infection; a remarkable 40 per cent of those with cerebral malaria had a urinary tract infection, pneumonia or septicaemia. Could immunosuppression induced by malaria and sometimes manifested by a relativ