Fibrinolytic activity in children with Plasmodium falciparum malaria

Background: Malaria infection is still one of the major causes of morbidity and mortality among the under five year children in tropical Africa. Clinical and laboratory methods of assessing the risk factors for severity in order to adequately manage these children, therefore needs to be identified so that prompt and adequate treatment can be instituted early. Fibrinolytic activity has been postulated as one of the risk factors associated with severity of malaria infection. Objective: To measure fibrinolytic activity euglobulin lysis time, (ELT) and fibrinogen levels in 50 Nigerian children with plasmodium falciparum infection. Design: A cross sectional study. Setting: University of Benin Teaching Hospital, Benin City, Nigeria between January and December 2002. Subjects: Fifty Nigerian children who were admitted with plasmodium falciparum malaria infection in the paediatric wards of the hospital were recruited into the study. Thirtyfour apparently healthy children who did not have malaria fever but who came for growth monitoring exercise and had some investigations done as part of this exercise were used as control for the study. The fibrinolytic activity in all the 84 children (both that had malaria infection and those who did not have malaria infection) were estimated by measuring the euglobulin lysis time (ELT). The fibrinogen levels in all the children were also estimated. The packed cell volume of the children was determined and some severely anaemic children had blood transfusions. Results: Euglobin lysis time (ELT) was found to be higher in children with plasmodium falciparum malaria infection (430 ± 149) than in the controls (158 ± 21.7, P< 0.01). Fibrinogen levels of 3.40 ± 0.98 in children with malaria infection were high when compared to 2.21 ± 0.81 in the controls. The children with malaria infection therefore had a decreased fibrinolytic activity and a proportionately high fibrinogen level. The average packed cell volume of the children with malaria infection was 29.64 ± 2.13 while in the control it was 36.41 ± 3.24. The study also showed that 50% of children with malaria had severe anaemia and subsequently had blood transfusions. Twenty percent of those who had transfusions died while being transfused. Conclusion: Children who have malaria infection have decreased fibrinolytic activity and proportionately high fibrinogen level which may contribute to the possible thromboembolic process in these children and hence higher risk of mortality from plasmodium falciparum malaria infection. East African Medical Journal Vol.82(2) 2005: 104-10