Serum Anti-Erythropoietin Autoantibodies and Their Association With Younger Age in Paediatric Malaria Cases.

Abstract

Background: Malaria remains a major public health concern, particularly among children under 5 years in the WHO African Region. Malarial anaemia is a common complication in this population. Factors that are associated with the development of malarial anaemia include haemolysis, dyserythropoiesis, erythrophagocytosis and bone marrow suppression, with studies reporting varying erythropoietin (epo) responses to severe anaemia. Studies on anti-epo antibodies being linked to malarial anaemia have yielded conflicting results, associated with malarial anaemia in pregnant women but not in children. This study sought to investigate anti-epo antibody production in children with malaria and explore their association with malarial anaemia.

Methodology: The study recruited 90 children aged 1-10 years in Tano North Municipality, Ghana. Of these, 60 children diagnosed with malaria (30 with anaemia and 30 without anaemia) formed the case group, while 30 healthy children served as the control group. Venous blood samples were collected into K₂EDTA (for full blood count, G6PD activity and malaria microscopy) and serum-separator tubes (SSTs) (sera for measurement of epo concentrations and anti-epo antibodies using ELISA kits).

Results: In all, anti-epo antibodies were detected in 5.6% of participants who had malaria, with none of the controls being positive for the antibodies. However, the difference in anti-epo antibody positivity between the two groups was not statistically significant. Within the subgroup of 30 malarial anaemia patients, 5.0% had anti-epo antibodies compared to 3.37% within the subgroup of malaria without anaemia (p = 0.640). Antibody positivity was significantly associated with elevated epo concentrations and younger age when compared to those with malaria who did not produce anti-epo antibodies.

Conclusion: Anti-epo antibody production is not linked to Plasmodium falciparum infection or malarial anaemia but is strongly associated with younger age and elevated epo levels in children.