Haemoglobinuria among children with severe malaria attending tertiary care in Ibadan, Nigeria

• Published in: Malaria Journal
• Main Authors: Ajetunmobi Wasiu A, Orimadegun Adebola E, Brown Biobele J, Afolabi Nathaniel K, Olabiyi Folorunso A, Anetor John I, Omokhodion Samuel, Osinusi Kikelomo, Akinbami Felix O, Shokunbi Wuraola A, Sodeinde Olugbemiro, Fernandez-Reyes Delmiro
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2012
• Subjects: Childhood severe malaria; Haemoglobinuria; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/1475-2875-11-336; https://doaj.org/article/abc69a07758b4b78b69b2bea0a06dc14

Abstract Background Haemoglobinuria is one of the manifestations of severe malaria and results from severe intravascular haemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency has been implicated in its aetiology. Haemoglobinuria may be associated with severe anaemia and, less frequently, acute renal failure. Methods A prospective case-control study was carried out to determine the incidence of haemoglobinuria as confirmed by dipstick urinalysis, microscopy and spectrophotometric measurement, among children with severe malaria. A total of 251 children presenting at the Children’s Emergency Ward with severe malaria were recruited over a period of 21 months. The G6PD status and the outcomes of severe malaria in children with and without haemoglobinuria was studied with respect to renal failure, the recurrence of haemoglobinuria and blood pressure changes over a three-month follow-up period. Results It was found that the incidence of haemoglobinuria among children with severe malaria is 19.1%. Children <5 years constituted 76.8% of all the study patients. Patients with haemoglobinuria had median age of 52.5 months, which was significantly higher than 35 months in patients without haemoglobinuria (p=0.001). Although, haemaglobinuria was commoner among boys (54.2%) than girls (45.8%), the difference was not statistically significant. There were no significant differences between children with and without haemoglobinuria regarding their nutritional status or parasite densities. Among the clinical features of the study patients, only jaundice was significantly associated with haemoglobinuria (p=0.0001). Renal failure occurred in three out of 48 children with haemoglobinuria and in none of the 203 without. There was not recurrence of haemoglobinuria in the follow-up period. At discharge, blood pressure was elevated in six children (one previously haemoglobinuric), but all returned to normal within the follow-up period. Conclusions Haemoglobinuria was a prominent feature of severe malaria and it was ...