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Original Article

The Effect of ABO Blood Groups, Hemoglobinopathy, and Heme Oxygenase-1 Polymorphisms on Malaria Susceptibility and Severity

Jiraporn Kuesap1, Kesara Na-Bangchang2,*
The Korean Journal of Parasitology 2018;56(2):167-173.
Published online: April 30, 2018

1Faculty of Allied Health Sciences, Thammasat University. 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*Corresponding author (kesaratmu@yahoo.com)
• Received: November 12, 2017   • Revised: March 20, 2018   • Accepted: April 10, 2018

Copyright © 2018 by The Korean Society for Parasitology and Tropical Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Effect of ABO Blood Groups, Hemoglobinopathy, and Heme Oxygenase-1 Polymorphisms on Malaria Susceptibility and Severity
Korean J Parasitol. 2018;56(2):167-173.   Published online April 30, 2018
DOI: https://doi.org/10.3347/kjp.2018.56.2.167
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The Effect of ABO Blood Groups, Hemoglobinopathy, and Heme Oxygenase-1 Polymorphisms on Malaria Susceptibility and Severity
Korean J Parasitol. 2018;56(2):167-173.   Published online April 30, 2018
DOI: https://doi.org/10.3347/kjp.2018.56.2.167
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The Effect of ABO Blood Groups, Hemoglobinopathy, and Heme Oxygenase-1 Polymorphisms on Malaria Susceptibility and Severity
The Effect of ABO Blood Groups, Hemoglobinopathy, and Heme Oxygenase-1 Polymorphisms on Malaria Susceptibility and Severity

The distribution of ABO blood group and malaria species infected in 100 blood samples

Plasmodium species O (%) A (%) B (%) AB (%) Total (%)
Plasmodium falciparum 9 11 12 3 35
Plasmodium vivax 27 13 19 4 63
Mixed infections with P. falciparum and P. vivax 1 1 0 0 2
Total 37 25 31 7 100

The distribution of ABO blood group and risk of developing severe malaria based on parasitemia and the anemic status of patients (levels of hemoglobin and hematocrit)

Variables Distribution in ABO group
O A B AB
Parasitemia (median and range, /μl blood)
 Plasmodium falciparum 15,776 (461–80,300) 7,200 (800–41,429) 9,703 (355–70,095) 1,608 (1,600–2,300)
 Plasmodium vivax 4,705 (64–74,667) 3,909 (50–12,000) 2,583 (150–42,988) 12,075 (1,563–12,808)
 Mixed infections with P. falciparum and P. vivax 2,920 (2,920–2,920) 22,720 (22,720–22,720) - -
Hemoglobin (%)
 Non-anemia (male ≥13, female ≥12 g/dl) 14 13 15 4
 Mild anemia (male 11–12.9, female 11–11.9 g/dl) 13 8 8 0
 Moderate anemia (8.0–10.9 g/dl for both genders) 6 5 3 2
 Severe anemia (<8.0 g/dl for both genders) 4 0 5 0
Hematocrit (%)
 ≥20 37 26 28 6
 <20 0 0 3 0
Risk of developing severe malaria (%)
 Low risk 30 25 25 7
 High risk (parasitemia (≥70,000/μl) and/or hemo- globin (<8.0) and/or hematocrit <20% 7 0a 6 0

aStatistically significant difference from patients with other blood groups (P =0.026).

The prevalence of thalassemia in 100 malaria infected samples

Thalassemia No. (%) Malaria Type Hb (g/dL) Hct (%) MCV (fl) MCH (pg)
PF PV Mixed
Malaria with thalassemia 30 9 20 1 11.5 (5.1–14.3) 34.3 (15.9–44.1) 71.0 (53.0–91.0) 23.2 (15.2–30.2)
 Hb E 14 3 10 1 11.8 (7.8–14.3) 35.5 (21.9–43.0) 73.5 (63.0–83.0)b 24.1 (20.5–27.4)f
 β-thalassemia 1 1 0 0 6.0 (6.0–6.0) 18.0 (18.0–18.0) 58.0 (58.0–58.0) 18.7 (18.7–18.7)g
 α-thalassemia 1 1 1 0 0 12.7 (12.7–12.7) 41.3 (41.3–41.3) 68.7 (68.7–68.7) 21.2 (21.2–21.2)
 α-thalassemia 2 10 3 7 0 12.0 (5.1–14.3) 35.5 (15.9–44.1) 73.5 (53.0–91.0)c 23.8 (15.2–30.2)
 Hb E/α-thalassemia 2 1 0 1 0 7.6 (7.6–7.6) 24.0 (24.0–24.0) 62.0 (62.0–62.0) 19.7 (19.7–19.7)
 β/α-thalassemia 2 3 1 2 0 10.9 (9.8–11.1) 33.6 (28.3–34.3) 67.0 (60.0–67.0)d 21.3 (19.6–22.7)h
Malaria without thalassemia 70 26 43 1 12.4 (3.4–17.7) 37.7 (10.7–55.1)a 84.5 (50.0–101.0)e 27.80 (20.8–32.3)i

aStatistically significant difference from samples with thalassemia (P=0.006).

bStatistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.002).

cStatistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.045).

dStatistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.007).

eStatistically significant difference from samples with thalassemia (P<0.001).

fStatistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.001).

gStatistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.043).

hStatistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.006).

iStatistically significant difference from patients with thalassemia (P<0.001).

The association of thalassemia and anemic status in malaria infected samples

Thalassemia Anemic status
Non- anemia (%) Mild anemia (%) Moderate anemia (%) Severe anemia (%)
Malaria with thalassemiaa 10 7 7 6
 Hb E 6 2 4 2
 β-thalassemiab 0 0 0 1
 α-thalassemia 1 0 1 0 0
 α-thalassemia 2 4 3 1 2
 Hb E/α-thalassemia 2c 0 0 0 1
 β/α-thalassemia 2 0 1 2 0
Malaria without thalassemia 36 20 11 3d

aStatistically significant difference from patients with thalassemia (P=0.016).

bStatistically significant difference from patients with other types of thalassemia and without thalassemia (P=0.023).

cStatistically significant difference from patients with other types of thalassemia and without thalassemia (P=0.023).

dStatistically significant difference from patients with other types of thalassemia (P=0.019).

Distribution of HO-1 promoter genotypes (S and L) including allele (S/S, S/L, and L/L) frequencies and malaria severity in 100 malaria infected samples

Number Malaria species Malaria severity
P. falciparum P. vivax Mixed infection UM RSM
Alleles, n (%)
 S 112 (56)
 L 88 (44)
Genotypes, (%)
 S/S 25 8 16 1 22 3
 S/L 62 25 37 0 53 9
 L/L 13 2 10 1 12 1

UM, uncomplicated malaria; RSM, risk to severe malaria.

Table 1 The distribution of ABO blood group and malaria species infected in 100 blood samples
Table 2 The distribution of ABO blood group and risk of developing severe malaria based on parasitemia and the anemic status of patients (levels of hemoglobin and hematocrit)

Statistically significant difference from patients with other blood groups (P =0.026).

Table 3 The prevalence of thalassemia in 100 malaria infected samples

Statistically significant difference from samples with thalassemia (P=0.006).

Statistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.002).

Statistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.045).

Statistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.007).

Statistically significant difference from samples with thalassemia (P<0.001).

Statistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.001).

Statistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.043).

Statistically significant difference from samples with other types of thalassemia and without thalassemia (P=0.006).

Statistically significant difference from patients with thalassemia (P<0.001).

Table 4 The association of thalassemia and anemic status in malaria infected samples

Statistically significant difference from patients with thalassemia (P=0.016).

Statistically significant difference from patients with other types of thalassemia and without thalassemia (P=0.023).

Statistically significant difference from patients with other types of thalassemia and without thalassemia (P=0.023).

Statistically significant difference from patients with other types of thalassemia (P=0.019).

Table 5 Distribution of HO-1 promoter genotypes (S and L) including allele (S/S, S/L, and L/L) frequencies and malaria severity in 100 malaria infected samples

UM, uncomplicated malaria; RSM, risk to severe malaria.

Table 1

Table 2

Table 3

Table 4

Table 5

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