Antioxidant Status of Sickle Cell Disease Children with and without Malaria at the Korle-Bu Teaching Hospital

Abstract

Background Sickle cell disease (SCD) is a hereditary disorder prevalent in malaria endemic areas, in which there is state of chronic vasculopathy characterized by endothelial dysfunction, and increased oxidative stress. SCD patients with malaria may experience worse outcomes because malaria infection in SCD leads to depletion of antioxidants which may complicate the disease. Few studies, however, have evaluated the antioxidant status of SCD patients with discrete clinical syndromes. There is also little information on the extent to which malaria depletes antioxidants in SCD patients. Setting The study was carried out at the Department of Child Health, Korle-Bu Teaching Hospital and the Centre for Tropical Clinical Pharmacology and Therapeutics. Aim The objective of the study was to investigate the levels of selected antioxidants in acutely ill sickle cell disease children with and without malaria. Methods Blood samples of 121 children between ages of 6 months and 13 years presenting with sickle cell and acute febrile illness were recruited. Known SCD children with confirmed malaria (n=26) or bacteremia (n=21) were enrolled. SCD children in steady state (n=21) visiting clinic for routine check- up as well as children with haemoglobin genotype, HbAA with malaria (n=26) and without malaria (n=25) attending the Korle-Bu Polyclinic were recruited. Relevant demographic data was recorded and clinical examination was undertaken. Haematological parameters as well as levels of the following antioxidants: reduced glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD) and ascorbic acid (ASC) were determined for each group. Results The mean levels of the antioxidants SOD, GSH and ASC was higher in non-SCD children, whowere malaria negative (AAM-) compared to SCD steady state children. The results for the anitoxidants were; SOD ( AAM- = 27.51, SCDSS= 25.85 ) U/ml, GSH( AAM- = 10800, SCDSS= 4465) mg/dl and ASC( AAM- = 3567, SCDSS= 2598) mg/dl. However, the reverse was found for GPx ( AAM- = 29.8, SCDSS= 259) U/, where mean activity was lower for non- sickle cell malaria negative children. Also, the mean levels of SOD, GPx and ASC in confirmed malaria positive children (SCDM+, AAM+) had lower activity than the non-malaria children (SCDSS, AAM-). Results for the antioxidant s were; SOD ( SCDSS =25.85, SCDM+=18.51 / AAM- =27.51 , AAM+= 23.99) U/ml , GPx ( SCDSS =259, SCDM+= 92.60 / AAM- =29.8, AAM+= 7.05) U/ml and ASC( SCDSS = 2598, SCDM+= 2401/ AAM- =3567, AAM+= 2514) mg/dl. However, the mean GSH ( SCDSS = 4465, SCDM+= 7941/ AAM- =10800, AAM+= 11700) mg/dl was higher for malaria positive compared to malaria negative groups.