Anaemia of acute malaria infections in non-immune patients primarily results from destruction of uninfected erythrocytes

G. N. JAKEMAN a1, A. SAUL a2c1, W. L. HOGARTH a3 and W. E. COLLINS a4
a1 School of Applied Mathematics and Statistics, Griffith University, Nathan, Queensland, 4111, Australia
a2 The Queensland Institute of Medical Research and University of Queensland, PO Royal Brisbane Hospital, Herston, Queensland, 4029, Australia
a3 Australian School of Environmental Studies, Griffith University, Nathan, Queensland, 4111, Australia
a4 Division of Parasitic Diseases, Mail Stop F-12, Center for Disease Control and Prevention, 4770 Buford Highway, Chamblee, GA 30341, USA


While anaemia has long been recognized as a consequence of acute infections with malaria, the relative contributions of direct erythrocyte destruction by parasites, destruction of uninfected erythrocytes and changes in erythropoiesis have been unclear. Fitting of parasitaemia and anaemia data from neurosyphilis patients undergoing malaria therapy to a mathematical model shows that in these patients, an average of 8·5 erythrocytes were destroyed in addition to each erythrocyte observed to become parasitized. The model also showed that dyserythropoiesis plays an insignificant role in the resulting anaemia. The anaemia occurs before a substantial antibody response to parasites or erythrocytes could be generated. We postulate that uninfected erythrocyte destruction occurs through phagocytosis of erythrocytes bound to merozoites killed as a result of the accompanying malaria paroxysms.

(Received November 25 1998)
(Revised February 11 1999)
(Accepted February 11 1999)

Key Words: anaemia; malaria; merozoite; modelling; Plasmodium falciparum.

c1 Corresponding author: The Queensland Institute of Medical Research Post Office, Royal Brisbane Hospital, Queensland 4029, Australia. Tel: +617 3362 0402. Fax: +617 3362 0104. E-mail: