The heads and the tails of malaria and VWF

In this issue of Blood, O'Regan et al have extended our understanding of von Willebrand factor (VWF) in the pathogenesis of malaria. According to the World Health Organization (http://www.who.int/gho/malaria/en/), malaria affects 3.2 billion people in 97 countries with 198 million cases having occurred in 2013, and of those, 584 000 died. Ninety percent of those deaths in 2013 were children under the age of 5. The most devastating form of the disease is cerebral malaria, which occurs most frequently in young children. Although blood coagulation changes such as disseminated intravascular coagulation have been recognized since the 1970s, recent studies have focused on markers of these hemostatic changes as being most prevalent in cerebral malaria caused by Plasmodium falciparum. Cerebral malaria is more lethal in children than adults. Exchange transfusion has been used as an aggressive adjunct therapy for this condition.