AN OBSERVATIONAL STUDY OF THE EFFECT OF HEMOGLOBINOPATHY, ALPHA THALASSEMIA AND HEMOGLOBIN E ON P. VIVAX PARASITEMIA
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Keywords
silent alpha-thalassemia, alpha-thalassemia trait, HbE, malaria, Southeast Asian
Abstract
Background: The protective effect of ?-thalassemia, a common hematological disorder in Southeast Asia, against Plasmodium falciparum malaria has been well established. However, there are much less well understood the effect of ?-thalassemia against P.vivax. Here, we aimed to investigate the proportion of ?-thalassemia including the effect of ?-thalassemia and HbE on the parasitemia of P.vivax in Southeast Asian malaria patients in Thailand.
Methods: A total of 210 malaria patients, admitted to the Hospital for Tropical Diseases, Thailand during 2011-2012, consist of 159 Myanmeses, 13 Karens, 26 Thais, 3 Mons, 3 Laotians, and 6 Cambodians were recruited. Plasmodium spp. and parasite densities were determined. Group of deletion mutation (--SEA, -?3.7, -?4.2deletion) and substitution mutation (HbCS and HbE) were genotyped using multiplex gap-PCR and PCR-RFLP, respectively.
Results: In our malaria patients, 17/210 homozygous and 74/210 heterozygous -?3.7 deletion were found. Only 3/210 heterozygous -?4.2 deletion and 2/210 heterozygous--SEA deletion were detected. HbE is frequently found with 6/210 homozygote and 35/210 heterozygote. The most common thalassemia allele frequencies in Myanmar population were -?3.7 deletion (0.282), followed by HbE (0.101), HbCS (0.016), -?4.2 deletion (0.009), and --SEA deletion (0.003). Only density of P.vivax in ?-thalassemia trait patients (-?3.7/-?3.7, --SEA/??, -?3.7/-?4.2) but not in silent ?-thalassemia (-?3.7/??, -?4.2/??, ??CS/??) were significantly higher compared with non ?-thalassemia patients (p=0.027). Density of P.falciparum significantly increased in heterozygous HbE patients (p=0.046).
Conclusions: Alpha-thalassemia trait is associated with high level of P.vivax parasitemia in malaria patients in Southeast Asia.
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