Comparative Hematologic Analysis of Uncomplicated Malaria in Uniquely Different Regions of Unstable Transmission in Brazil and Colombia

Information on malaria-associated anemia in adult patients is scarce in South American populations. From 2004 to 2006, malaria patients 18 to 45 years of age were recruited in a descriptive cross-sectional study from two different towns: Manaus, in the Brazilian Amazon (120 patients) where Plasmodium falciparum incidence is lower ( approximately 20%), and in Tumaco on the Colombian Pacific Coast (126 patients) where P. falciparum incidence is higher ( approximately 90%). Relationships between hematologic parameters and independent variables were explored using cross-tabulations and multiple linear regression analyses. We found an inverse relationship of hemoglobin (Hb) levels with days of illness in both sites. In Manaus but not in Tumaco, red cell distribution width (RDW) was related to asexual parasitemia. Reticulocytes were higher in Plasmodium vivax infection in Tumaco. Only in Tumaco, two patients with P. falciparum infection presented with severe anemia (Hb < 7 g/dL). Etiologic factors associated with hematologic changes in malaria seem to be multifactorial. More studies are needed to clarify the anemia determinants in uncomplicated malaria in South America, where malaria transmission is mostly unstable.