Anemia and relationship with cytokines TH1 and TH2, in patients with malariaFerritin deficiency is defined basically as the reduction of iron in the body and its diagnosis when not associated with anemia is based on quantification of serum ferritin.However, determinations of serum levels of this protein, which are performed systematically to determine the iron status, ferritin acts as a positive acute phase reactant in the presence of inflammatory/infectious disease clinics and subclinics (Aleo et al., 2004) as happens during malaria.This explains why this protein is not useful tool for evaluating iron stores, and in contrast, constitutes a good indicator of inflammatory status along with the C reactive protein (CRP).CRP is produced by the liver, is also known as a positive acute phase reactant during malaria and main function is to join the organism, acting as an opsonin, with activation of the classical complement pathway, which is responsible for recruitment of inflammatory cells, opsonization and dead direct of the pathogen (Marsh & Kinyanjui, 2006).Unlike ferritin, hemoglobin is not considered a reactant acute phase and the low concentrations of blood, result in anemia, which is a public health problem in many regions around the world with a high prevalence in economically dependent countries, especially among children and resulting from the interaction between biological, nutritional and cultural factors (Blair et al., 1999).The Anemia is a common complication of malaria and the mechanisms originally involved have not yet been fully defined.The cause is multifactorial and includes aspects related to the increase destruction of parasitized and non-parasitized cells and other factors causing a decreased production of erythrocytes, by alteration in the maturation of erythroid precursors or lack on response of bone marrow to erythropoietin (EPO).Additionally, there are others conditioning agents of anemia related with the characteristics of the parasite and host as resistance to Plasmodium or some disease in the host as well as thalassemia or sickle cell anemia, which enhances the severity of anemia, as well as deficiencies of iron and other micronutrients (Llanos et al., 2004).In adults living in Kenya with acute malaria by P. falciparum found that TNF-, interleukin 1 (IL-1) and IL-6, cytokines produced by monocytes, suppresses the synthesis of erythropoietin (Vedovato et al., 1999).Similar results were seen in children in Ghana (Kurtzhals et al., 1999).In Uganda, children 1 to 10 years who had acute uncomplicated malaria by P. falciparum, the authors found that age, high concentrations of erythropoietin, low concentrations of -1 glycoprotein, and IL-10/TNF- high proportion were associated with significantly increased hemoglobin concentrations.These data indicate that children younger with malaria do not maintain the production of IL-10 in response to inflammatory process, a mechanism that may contribute to the severity of the anemia (Nussenblatt et al., 2001).A study in Kenya in children with malaria revealed that the TNF- and IL-10 were significantly higher in those subjects with high parasitemia and anemia, compared with control group, the same age and sex, but without malaria (Othoro et al., 1999).In children Colombians living in El Bagre (Colombia), aged from 4 to 9 years old who had acute uncomplicated malaria, 67% P. vivax, 29% P. falciparum and 4% mixed infection was found average of IL-10 of 266.18 ± 47.9 pg/ml, highly significant and higher than in children with the same age, but not malaria, which was 8.52 ± 1.17 pg/ml (P <0,001); the values of IL-10 in children with malaria correlated with parasitaemia and body temperature.Conversely, TNF- was only detected in 12% of study subjects, no significant differences between average children malaria and those without the disease.In children with moderate or high parasitemia but not anemia, the proportion was IL-10/TNF- significantly higher compared with those who did have anemia, indicating that high values of this proportion can prevent www.intechopen.com
