Study of Red Cell Deformability, Nitric Oxide and Hematological Parameters in confirmed uncomplicated Falciparum Malaria patients
Malaria is today a disease of poverty in underdeveloped countries. The aim of the present study was to study the red cell deformability (RCD), plasma nitric oxide level (NO) and hematological parameters in confirmed uncomplicated Falciparum Malaria (CUM) patients. In addition, the factors affecting red cell deformability and the effect of in-vitro changes in pH, osmolality and glucose concentrations on red cell deformability of CUM patients and normal controls were also investigated.
Thirty confirmed uncomplicated Falciparum Malaria patients, ages between 20 and 40 years, and age matched 12 normal healthy controls had participated in this study. Plasma nitric oxide level and hematological parameters such as RCD, red cell count, mean cell volume(MCV), red cell distribution width (RDW), mean corpuscular hemoglobin concentration (MCHC) and plasma proteins such as fibrinogen and albumin concentration were determined.
Deformability of red blood cells was determined using in-vitro filtration model, fibrinogen concentration using precipitation method, albumin concentration using dye-binding method; nitric oxide level using Greiss method and hematological parameters using automatic hematology analyser. The effect of pH, osmolality and fibrinogen on red cell deformability was studied by incubating the washed red cells of both patients and healthy subject’s in-vitro with phosphate buffered saline of different concentrations of pH, osmolality and fibrinogen concentration.
The RCD, red blood cell count, hemoglobin concentration, hematocrit, white blood cell count and platelet count were found to be significantly lower in the CUM patients than in the healthy adults. On the other hand, the NO level, red ell distribution width, mean platelet volume and albumin concentration were significantly higher in the CUM patients than in the healthy adults.
It was found that RCD was significantly correlated with red blood cell count, hemoglobin concentration, and hematocrit and fibrinogen concentration in normal subjects. In CUM patients, the RCD was found to be significantly correlated with NO, red cell count and hemoglobin concentration, hematocrit and significantly but inversely correlated with RDW. The NO level was positively correlated with red blood cell count and hemoglobin concentration in CUM patients.
It was also found that red blood cell deformability is influenced by pH and osmolality, and the deformability is best at optimal pH and osmolality. It was observed that RCD was decreased with increasing concentration of fibrinogen in-vitro.
These findings indicated that red blood cell deformability is reduced in Falciparum Malaria and is influenced by plasma nitric oxide level. Changes in plasma factors that occur concomitantly with reduction in red cell deformability in malaria patients might be indicative of their pathophysiological importance in clinical manifestation of malaria. Alterations in RCD, NO and hematological parameters seem to occur even from the outset of malaria, and changes in plasma factors rather than properties of red cells contribute more to reduction of RCD in CUM patients.
The Aims, Objects, Results and Conclusion of the Thesis reproduced as Abstract are as give above.
However, the main purpose in publishing this Thesis in MJCMP is to introduce to General Practioner in the townships and periphery, and even to post some graduates and specialists the concept of red cell deformability in relation to capillary diameter and the role it may play in the pathophysiology of various diseases affecting microcirculation capillary diameter versus red cell deformability. Moreover the author has been able to find a method of measuring RCD which is relatively easy to use in Myanmar as given in the literature review of the Full Thesis.
OhnmarMyint Thein, Associate Professor, Department of Physiology, University of Medicine 1, Yangon
MyatThandar, Rector, University of Nursing, Yangon
