Alterações cito-histológicas na medula óssea de pacientes com malária aguda por Plasmodium falciparum

Abstract

Introduction: Malaria is one of the most serious health problems affecting Brazilians, and it is in the Amazon area that one can find the largest number of people affected by the disease. In that region, the State of Amazonas is by far, the place that presents the highest incidence of the illness. Malaria brings a strong impact on personal and collective grounds and is considered the most debilitating disease affecting residents of that large area of land. Such epidemiological importance plus an outstanding harm to the hematopoietic sector imposes the need for studies that enhance a better understanding of the problem as proposed by this research. Methods: A study of a 29 patient group with falciparum malaria, primo-infected and no previous treatment, all older 15 years of age, admitted to the Tropical Medicine Foundation of Amazonas from 1998 to 1999. Clinical and laboratory data (hematology, biochemistry), myelogram and bone marrow biopsy collected from patients were analyzed to identify changes resulting from bone marrow impairment in acute malaria caused by Plasmodium falciparum. Results: The patients studied had low levels of parasitemia (52%), thrombocytopenia with platelet counts in peripheral blood, varying inversely to peripheral parasitemia (p value 0.016), hemolysis presumed positive by Coombs test in 16 patients; dyserithropoiesis, dysmegakariopoiesis and leukocyte phagocytosis in a total of 152 dyspoietics events involving the three medullary series and presence of lymphoid aggregates (17.24%) Conclusions: Acute malaria caused by Plasmodium falciparum in this study provided important changes that affect cell maturation in bone marrow, primarily in erythroid and megakaryocytic lineage, besides causing the appearance of uncertain evolutionary potential lymphoid aggregates.