Malaria (Figs 46.1 and 46.2)
Anaemia is caused by haemolysis (cellular disruption and haemoglobin digestion), splenic sequestration, haemodilution (raised plasma volume) and ineffective erythropoiesis. Malarial antigens attached to red cells may cause immune haemolysis. Acute intravascular haemolysis with haemoglobinuria and renal failure (blackwater fever) occurs rarely in Plasmodium falciparum infection. Anaemia of chronic disease may also occur. Eosinophilia is variable. Thrombocytopenia occurs in in up to 70% of P. falciparum infections and is caused by immune destruction, splenic sequestration and disseminated intravascular coagulation (DIC).
Leishmaniasis
Visceral leishmaniasis is a protozoal infection caused by Leishmania donovani. Hepatosplenomegaly, hypergammaglobulinaemia, normochromic anaemia and a raised erythrocyte sedimentation rate (ESR) occur. Bone marrow aspirate shows macrophages containing Leishman–Donovan bodies (Fig. 46.3). Treatment is with pentavalent antimonial compounds or with amphotericin B (AmBisone).
Filariasis
Lymphatic filariasis is usually caused by the filarial worm Wuchereria bancrofti
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