Influence of ABO Blood Group Homozygous and Heterozygous Alpha Thalassemia on the Severity of Falciparum Malaria in India

Author(s): Jagannath Hati1 , Gouri Oram2 , Purna Chandra Karua3

BACKGROUND Malaria is a global health burden. About 300 - 500 million people suffer from the disease every year, out of whom, about 1 million succumb.1 This study was undertaken, as there has been no such study regarding the possible effect of ?- thalassemia and ABO blood group in Indian population on falciparum malarial infection. METHODS This is an observational study carried on in all malarial patients admitted in the Department of General Medicine, VSS Medical College & Hospital, Burla, between October 2008 - September 2010. Inclusion criteria: (i) Fever with positive asexual forms of falciparum malarial parasites [thick smear, thin smear, positive quantitative buffy coat (QBC), ICT test]. (ii) WHO criteria for severe falciparum malaria2 . “Controls”: Healthy persons of about same age, sex, ethnicity and locality. Exclusion Criteria: Blood transfusion within 3 months, cases of DM, CKD, hepatitis, SCD, tuberculosis, HIV, chronic liver disease, and COPD. RESULTS 128 cases of malaria, between 15 - 75 years, both sexes, pregnant / non-pregnant were included in the study. For control, the gene frequencies were ?? / ?? 29 (45.3 %), ? 3.7 / ?? 27 (42.2 %) and ?3.7 / ?3.7 8 (12.5 %). For cases, it was found 33 (51.56 %), 25 (39.1 %) and 6 (9.4 %) respectively. In HPLC, HbA0 values of ?3.7 / ?3.7 (81.83 ??? 10) were > ?? / ?? (77.11 ??? 21.6) > ? 3.7 / ??, (64.8 ± 32.42), HbA2 values of ?? / ?? (2.1 ??? 1.4) > ? 3.7 / ?? (1.8 ± 0.8) > ?3.7 / ?3.7 (1.43 ??? 0.27). In HbF, there were nearly same number of cases in all three variants and were negligible in HbS. Anaemia, jaundice, oliguria were the predominant causes of morbidity in alpha thalassaemic patients with severe falciparum malaria. Blood group A patients had significantly higher morbidity than blood group B, AB and O. CONCLUSIONS The percentage of anaemia, coma, convulsion and death was significantly less in homozygous alpha thalassemia cases in comparison to normal alpha thalassemia and heterozygous alpha thalassemia. Above features were also found to be significantly less in blood group O patients, and significantly high in blood group A patients, when compared to other blood groups. Prevalence of heterozygous and homozygous ?-thalassemia was lower in cases in comparison to controls. MCV was significantly lower in homozygous alpha thalassemia patients in comparison to other genotypes of alpha thalassemia. Anaemia, jaundice, coma, shock, oliguria, being the major co-morbidity conditions, should be detected and treated early.