RESUMEN
BACKGROUND: Plasmodium falciparum malaria remains one of the world's major infectious diseases that cause most morbidity and mortality, particularly in children. In Ghana, most children below the ages of 5 years depending on the severity of the infection often lose their lives. However, it is still debatable why infection with falciparum malaria contributes to thrombocytopenia. METHODS: This study sought to investigate the expression of the various platelet indices and activation markers in children with falciparum malaria. Platelet indices (Platelet count [PLT], Plateletcrite [PCT], Mean Platelet Volume [MPV], Platelet Distribution Width [PDW] and Platelet-Large Cell Ratio [P-LCR]) and platelet surface membrane glycoproteins (GPIIb/IIIa [PAC-1], P-selectin [CD62p] and GPIV [CD36]) expressions were determined in children with falciparum malaria (cases) and healthy children (controls) using automated blood cell analysis and flow cytometry techniques, respectively. RESULTS: Except for P-LCR, all the other platelet indices (PLT, MPV, PDW, and PCT) were significantly lower in the cases than the controls (P < 0.05). Also, it was observed that the level of expression of the activation markers; PAC 1 and CD62p showed a significant (P < 0.05) decreased before and after activation in falciparum malaria cases than in the controls. On the contrary, CD36 expression in the controls did not differ significantly (p > 0.05) from the malaria cases. Platelet activation markers were known to be associated with increased risk of falciparum malaria with the mean fluorescence intensity of PAC1 (Odds Ratio [OR] 34.0, Relative Risk [RR] 4.47, 95% Confidence Interval [CI] 4.904-235.7; p < 0.0001) and CD36 (OR 4.2, RR 1.82, 95% CI 0.9824-17.96; p = 0.04). Moreover, the percentage expression of CD62p (OR 4.0, RR 1.80, 95% CI 0.59-27.24; p = 0.19) was also observed to be probably associated with increased risk of falciparum malaria although not statistically significant (p > 0.05). CONCLUSION: Plasmodium falciparum malaria has been known to be associated with platelet activation markers, which probably contributes to thrombocytopenia.
Asunto(s)
Plaquetas/fisiología , Pruebas Hematológicas , Malaria Falciparum/sangre , Activación Plaquetaria , Adolescente , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Citometría de Flujo , Ghana , Humanos , Masculino , Selectina-P/sangreRESUMEN
BACKGROUND: Type 2 diabetes mellitus (T2DM) patients are predisposed to several diabetes-related complications. Dysregulation of the haemostatic mechanisms have been implicated. There are however no current studies assessing the levels and activity of protein C (PC), protein S (PS), and antithrombin III (AT III), which are essential in haemostatic regulation, in a single cohort of T2DM patients. This study evaluated the effect of poorly-managed T2DM on the levels and activity of PC, PS, and AT III. METHODS: This cross-sectional study was conducted at the Diabetes Clinic, Cocoa Clinic in Kumasi, Ghana. A total of 242 T2DM patients, comprising 152 patients with poorly-managed diabetes and 90 well-managed diabetes patients, were recruited for the study. Fasting blood glucose, liver function tests and lipid profile were performed for each respondent. Glycated haemoglobin (HbA1c) was estimated by turbidimetric inhibition immunoassay. The levels and activity of PC, PS and AT III were measured by solid phase sandwich ELISA method. RESULTS: There was a negative correlation between HbA1c and the levels and activity of PC, PS and AT III. The levels and activity of PC [(5.78 vs 4.64 µg/ml, p<0.0001) and (42.22 vs 36.21 U/ml, p = 0.01) respectively], PS [(22.55 vs 20.29 µg/ml, p = 0.010) and (235.94 vs 211.67 U/ml, p<0.0001) respectively] and AT III [(16.28 vs 14.41µg/ml, p<0.0001) and (176.01 vs 160.09 U/ml, p = 0.03) respectively] were significantly increased in patients with well-managed T2DM compared to the poorly-managed diabetes patients. Likewise, the levels and activity of PC, PS, and AT III was higher among T2DM patients using statins than patients who were statin-naïve. Among patients with well-managed T2DM, those who were on statins had significantly higher levels and activities of PC, PS, and AT III compared to well-managed T2DM patients not on statins. However, there no statistically significant differences between the level and activity of PC, PS, and AT III among poorly-managed T2DM patients with respect to statin status. CONCLUSION: Poorly-managed type 2 diabetes mellitus is associated with reduced levels and activity of PC, PS and AT III compared to well-managed T2DM. Though use of statins may improve the levels and activity of the PC, PS and AT III in T2DM, their effect is limited in the presence of poorly-controlled T2DM. Proper management of diabetes is essential to reduce the likelihood of thrombotic events among T2DM patients.
Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hipoglucemiantes/administración & dosificación , Trombosis/prevención & control , Adulto , Anciano , Antitrombina III/análisis , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Proteína C/análisis , Proteína S/análisis , Trombosis/sangre , Trombosis/etiología , Resultado del TratamientoRESUMEN
Platelet activation and functional changes in some haematological malignancies have been investigated with little or no known documentation on Burkitt lymphoma (BL). Abnormalities of platelets contribute to either haemorrhage or thrombotic episodes which are life-threatening in patients with BL. Thus, the study aimed at investigating the various platelet indices and platelet membrane glycoproteins in childhood Burkitt lymphoma. Platelet surface membrane glycoproteins (GPIIb/IIIa, P-selectin and GPIV using PAC 1, CD62p and CD36 monoclonal antibodies respectively) and platelet indices (Platelet Count [PLT], Plateletcrite [PCT], Mean Platelet Volume [MPV], Platelet Distribution Width [PDW] and Platelet Large Cell Ratio [P-LCR]) were determined in children with Burkitt lymphoma and healthy children (normal controls) based on flow cytometry and automated blood cell analysis techniques. PLT and PCT were higher in BL cases than in the normal controls with a significant difference in the PLT (P = 0.02). On the contrary, we observed a significant (p < 0.05) lower levels in the other platelet indices (MPV, PDW and P-LCR) in children with BL than the controls. With the exception of CD62 P, the other platelet membrane glycoproteins examined showed a decreased level of expression before and after the addition of an Adenosine -5- diphosphate (ADP) in cases of BL. In addition, PAC-1 was probably known to be associated with Burkitt Lymphoma (Odds Ratio [OR] 6.67, Relative Risk [RR] 3.13, 95% CI 1.06-9.21; p = 0.02). Finally, oral bleeding was observed to be the commonest bleeding episodes associated with childhood BL. Flow cytometry analysis and cell counting techniques of platelet assessment has described the expression of the platelet membrane glycoproteins and parameters in children with Burkitt lymphoma. Thus, children with Burkitt lymphoma tend to show normal to increased level of circulatory platelets but decreased platelet membrane glycoprotein expressions and platelet dysfunction.
Asunto(s)
Plaquetas/metabolismo , Linfoma de Burkitt/etiología , Linfoma de Burkitt/metabolismo , Regulación Neoplásica de la Expresión Génica , Glicoproteínas de Membrana Plaquetaria/genética , Factores de Edad , Biomarcadores , Pruebas de Coagulación Sanguínea , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/patología , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Activación Plaquetaria , Glicoproteínas de Membrana Plaquetaria/metabolismoRESUMEN
INTRODUCTION: The pathophysiology of malaria-related anaemia is not fully understood although increased destruction of parasitized and nonparasitized erythrocytes, as well as inadequate erythropoiesis, has been proposed. Circulating antierythropoietin (anti-EPO) antibodies have also been implicated in malaria and malaria-related anaemia in mice. However, studies on this association have not been investigated in humans. This study therefore determined the prevalence of anti-EPO antibody production and assessed its association with malaria and malaria-related anaemia in humans. METHODS: A total of 86 children aged 1-10 years (57 children with malaria serving as the case group and 29 healthy children serving as control), all residents of Duayaw Nkwanta, Ghana, were recruited for this case-control study. Venous blood was collected for thick and thin films for malaria microscopy, full blood count by automated haematology analyzer, and antierythropoietin antibody and erythropoietin estimation by sandwich ELISA method. RESULTS: Out of the 86 participants recruited, only 3 (3.5%) were positive for anti-EPO antibody; 2.3% of the case group; and 1.2% of the control group. There was no association between the cases and the controls in the production of anti-EPO antibodies. Erythropoietin concentration was significantly higher in malaria-related anaemic subjects (p=0.032). CONCLUSION: Antierythropoietin antibodies are not associated with malaria infection and malaria-related anaemia in humans. Erythropoietin concentration is associated with malaria-related anaemia.