Association between Serum Ferritin Levels and Metabolic-associated Fatty Liver Disease in Adults:a Cross-sectional Study Based on the NHANES

Objective Ferritin,initially acting as an iron-storage protein,was found to be associated with metabolic diseases.Our study was designed to investigate the association between serum ferritin and metabolic-associated fatty liver disease(MAFLD)using data from the National Health and Nutrition Examination Survey(NHANES)of the United State of America.Methods A cross-sectional study was conducted,enrolling a total of 2145 participants from the NHANES in the 2017–2018 cycles.Hepatic steatosis and liver fibrosis were assessed by ultrasound images and several non-invasive indexes.Multiple regression analysis was conducted to determine the associations between serum ferritin concentration and MAFLD and liver fibrosis.Results The analysis revealed that participants with higher serum ferritin levels(Q3 and Q4 groups)had a higher prevalence of MAFLD than those with the lowest serum ferritin levels[Q3 vs.Q1:OR=2.17(1.33,3.53),P<0.05 in fatty liver index(FLI);Q4 vs.Q1:OR=3.13(1.91,5.13),P<0.05 in FLI].Additionally,participants with the highest serum ferritin levels(Q4 group)displayed a higher prevalence of liver fibrosis[Q4 vs.Q1:OR=2.59(1.19,5.62),P<0.05 in liver stiffness measurement;OR=5.06(1.12,22.94),P<0.05 in fibrosis-4 index],with significantly increased risk observed in participants with concomitant diabetes[OR=7.45(1.55,35.72),P=0.012].Conclusion Our study revealed that elevated serum ferritin levels are associated with a higher prevalence of MAFLD and advanced liver fibrosis in patients.Elevated serum ferritin levels combined with diabetes are important risk factors for liver fibrosis.

Role of doxycycline in the treatment of dengue infection: An open-label, randomized, controlled, pilot trial

Objective:To measure the effect of doxycycline on inflammatory marker[IL-6,TNF-α,ferritin and C reactive protein(CRP)]levels in patients with dengue infection.Methods:A single-centre,open-label,parallel-group randomized controlled trial was done in PGIMER Chandigarh from June 2021 to October 2022.Patients were randomized using a simple randomization process into two groups:the doxycycline treatment group(n=35)and the control group(n=34).Patients in the treatment group were given oral doxycycline 100 mg twice daily for five days along with standard treatment,whereas patients in the control group received only standard treatment.The objective was to measure the effect of doxycycline on inflammatory markers in dengue infection.Results:On comparative analysis at day 5,there was a statistically significant reduction in the median values of ferritin and CRP in cases compared to the control group(ferritin:P=0.006 and CRP:P=0.006).No significant reduction was noted in the levels of IL-6 and TNF-α.Conclusions:Doxycycline treatment led to a reduction of inflammatory markers in dengue infection.

Study on The Method of Quantitative Analysis of Serum Ferritin and Soluble Transferrin Receptor with Protein Microarray Technology

Objective To establish and evaluate a protein serum ferritin （SF） and soluble transferrin receptor microarray method for combined measurement of （sTfR）. Methods Microarrayer was used to print both anti-SF antibodies I and anti-sTfR antibodies I on each protein microarray. Anti-SF antibodies II and anti-sTfR antibodies II were used as detection antibodies and goat antibodies coupled to Cy3 were used as antibodies Ill. The detection conditions of the quantitative analysis method for simultaneous measurement of SF and sTfR with protein microarray were optimized and evaluated. The protein microarray was compared with commercially available traditional tests with 26 serum samples. Results By comparison experiment, mouse monoclonal antibodies were chosen as the probes and contact printing was chosen as the printing method. The concentrations of SF and sTfR probes were 0.5 mg/mL and 0.5 mg/mL respectively, while those of SF and sTfR detection antibodies were 5 μg/mL and 0.36 μg/mL respectively. Intra- and inter-assay variability was between 3.26% and 18.38% for all tests. The regression coefficients comparing protein microarray with traditional test assays were better than 0.81 for SF and sTfR. Conclusion The present study has established a protein microarray method for combined measurement of SF and sTfR.

Serum ferritin levels in children with attention deficit hyperactivity disorder and tic disorder

BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.

Study on the Correlation between the Expression of Serum Ferritin and Gestational Diabetes Mellitus

Objective: To explore the relationship between serum ferritin (SF) and gestational diabetes mellitus (GDM), for providing new ideas to the prevention and treatment of GDM. Methods: All the pregnant women were selected in Yinan Maternal and Child Health-Care Hospital from December, 2015 to March, 2018 when they were having routine prenatal examination, According to the diagnostic criteria of GDM, 72 patients with GDM were selected as the case group and 72 normal pregnant women were randomly selected as the control group. Fasting venous blood was drawn from all subjects during the first trimester of pregnancy (11-13 weeks) and the second trimester of pregnancy (24-28 weeks). Fasting plasma glucose was measured by glucose oxidase assay and the expression level of SF was determined by electrochemical method. The application value of SF in GDM diagnosis was evaluated by ROC curve. Results: The levels of SF in the case group at early and middle stages are 49.6 ± 18.8 (μg/ml) and 39.8 ± 21.5 (μg/ml), which re 39.4 ± 15.2 (μg/ml) and 32.2 ± 17.6 (μg/ml) in the control group. The levels of SF in the case group were higher than those in the control group (p < 0.05) at early and middle stages. The curve (AUC) of SF level in the diagnosis of GDM was 0.895, p < 0.001; the Youden index was 0.651 and the optimum threshold was 38.6 ng/ml, with a sensitivity of 97.8% and a specificity of 67.3%. Conclusion: The expression level of SF in early pregnancy is correlated with the occurrence of GDM, which may be an important indicator for the prevention and monitoring of GDM.

Prognostic role of pretreatment serum ferritin concentration in lung cancer patients:A meta-analysis

BACKGROUND The association between pretreatment serum ferritin concentration(SFC)and long-term survival in lung cancer remains unclear now.AIM To identify the prognostic value of pretreatment SFC in lung cancer patients based on current evidence.METHODS The PubMed,EMBASE and Web of Science databases were searched from inception to May 29,2022 for relevant studies.The primary endpoint was overall survival(OS)and the hazard ratios(HRs)with corresponding 95%confidence intervals(CIs)were combined to assess the predictive role of pretreatment SFC for long-term survival of lung cancer patients.The data were then extracted and assessed on the basis of the Reference Citation Analysis(https://www.reference citationanalysis.com/).RESULTS Twelve retrospective studies involving 1654 patients were analyzed.The results manifested that increased pretreatment SFC was associated with worse OS(HR=1.09,95%CI:1.03-1.15,P=0.004).Subgroup analysis stratified by the country(China vs non-China)showed similar results.However,subgroup analysis stratified by tumor type revealed inconsistent results(lung cancer:HR=1.39,P=0.008;small cell lung cancer:HR=1.99,P=0.175;non-small cell lung cancer:HR=1.03,P=0.281).CONCLUSION Pretreatment SFC might serve as a promising prognostic indicator in lung cancer patients and elevated pretreatment SFC predicts worse prognosis.However,more high-quality studies with big sample sizes are still needed to further verify its prognostic value in lung cancer.

Analysis of Serum Ferritin Level and Its Clinical Value in Advanced Gastric Cancer

Objective: To investigate the concentration and clinical significance of serum ferritin (SF) in patients diagnosed with advanced gastric cancer before and after treatment. Methods: Forty patients with advanced gastric cancer diagnosed by cytology or pathology in our hospital were selected, including 25 males and 15 females, aged from 48 to 85 years, and the median age was 61.0 years. 40 healthy volunteers matched with age and education were selected as the control group. In order to study the changes of SF level in the treatment of advanced gastric cancer, we divided the patients into effective group (efficacy evaluation as partial remission or complete remission), ineffective group (efficacy evaluation as no remission) and recurrence group according to the efficacy after treatment. Then the difference of SF level between different groups and the relationship between SF level and curative effect were analyzed. There was no significant difference in gender and age among all groups. Results: The SF levels in the newly diagnosed group, stage III patient group and stage IV patient group were significantly higher than those in the control group. The level of SF in stage IV patients was significantly higher than that in stage III patients. There were significant differences in SF level between the effective treatment group, the newly diagnosed group and the ineffective treatment group, but there was no significant difference in SF level between the newly diagnosed group and the ineffective treatment group. Conclusion: SF level has a certain value in the auxiliary diagnosis of gastric cancer, and it also has a certain guiding significance for the evaluation of curative effect and prognosis after treatment.

The Potential Clinical Significance of the Serum Iron and Ferritin Status in Lung Cancer Patients

Background An increasing number of studies have shown that iron,one of the indispensable trace elements in the human body,is closely related to the occurrence and development of cancer.However,few studies have clearly demonstrated the role of the iron levels in lung cancer patients,or the potential effects of inflammation on iron levels.Methods The clinical data for lung cancer patients and non-lung cancer participants were retrospectively analyzed.The serum iron and ferritin levels were measured and compared using a rank-sum test.The correlation between the serum iron/ferritin and C-reactive protein(CRP)was analyzed by rank correlation.The cut-off values for continuous variables were obtained by the receiver operating characteristic curve(ROC)method.An analysis of potential prognostic factors in lung cancer patients was conducted by univariate and multivariate survival analyses.Results The serum iron levels in patients with extensive small-cell lung cancer(SCLC)were lower than those with limited-stage SCLC,and the levels of serum ferritin and CRP in those with extensive SCLC were higher than those with limited-stage SCLC.Similarly,the serum iron levels in patients with stage IV non-small cell lung cancer(NSCLC)were lower than those of patients with stageⅠ-Ⅲdisease,and the levels of serum ferritin and CRP in those with stage IV NSCLC were higher than those in stagesⅠ-Ⅲ.The serum iron level was negatively correlated with the level of CRP,while the serum ferritin level was positively correlated with CRP.The stage of lung cancer,but not the serum iron/ferritin level,was an independent prognostic factor in lung cancer patients.Conclusions The serum iron and ferritin levels are associated with the staging of lung cancer.The later stages of lung cancer are associated with a lower serum iron level,a higher serum ferritin level,and a higher CRP level.Inflammation may play an important role in regulating the serum iron and ferritin levels in lung cancer patients.

Hyperferritinemia is a risk factor for steatosis in chronic liver disease

AIM: To investigate the relationship between ferritin and steatosis in patients with chronically abnormal liver function tests (LFTs) and high ferritin level. METHODS: One hundred and twenty-four consecutive patients with hyperferritinemia (male > 300 ng/mL, female > 200 ng/mL) were evaluated; clinical, biochemical and serological data, iron status parameters, HFE gene mutations and homeostasis model assessment score were obtained. Steatosis was graded by ultrasound as absent or present. Histology was available in 53 patients only. RESULTS: Mean level of ferritin was 881 ± 77 ng/mL in men and 549 ± 82 ng/mL in women. The diagnosis was chronic hepatitis C in 53 (42.7%), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in 57 (45.9%), and cryptogenic liver damage in 14 (11.3%). None was diagnosed as hereditary hemochromatosis (HH). Hepatic siderosis on liver biopsy was present in 17 of 54 (32%) patients; grade 1 in eight and grade 2 in nine. Overall, 92 patients (74.2%) had steatosis. By logistic regression, ferritin and γ-glutamyltransferase were independent predictors of steatosis. Ferritin levels were signifi cantly related to low platelet count, steatosis and hepatitis C virus infection. CONCLUSION: In a non-obese cohort of non-alcoholic patients with chronically abnormal LFTs without HH, high serum ferritin level is a risk factor for steatosis.

Hepatocellular injury and the mortality risk among patients with COVID-19: A retrospective cohort study

BACKGROUND Clearly,infection with severe acute respiratory syndrome coronavirus 2 is not limited to the lung but also affects other organs.We need predictive models to determine patients’prognoses and to improve health care resource allocation during the coronavirus disease 2019(COVID-19)pandemic.While treating COVID-19,we observed differential outcome prediction weights for markers of hepatocellular injury among hospitalized patients.AIM To investigate the association between hepatocellular injury and all-cause inhospital mortality among patients with COVID-19.METHODS This multicentre study employed a retrospective cohort design.All adult patients admitted to Al-Azhar University Hospital,Assiut,Egypt and Abo Teeg General Hospital,Assiut,Egypt with confirmed COVID-19 from June 1,2020,to July 30,2020 were eligible.We categorized our cohort into three groups of(1)patients with COVID-19 presenting normal aminotransferase levels;(2)patients with COVID-19 presenting one-fold higher aminotransferase levels;and(3)patients with COVID-19 presenting two-fold higher aminotransferase levels.We analysed the association between elevated aminotransferase levels and all-cause in-hospital mortality.The survival analysis was performed using the Kaplan–Meier method and tested by log-rank analysis.RESULTS In total,376 of 419 patients met the inclusion criteria,while 29(8%)patients in our cohort died during the hospital stay.The median age was 40 years(range:28-56 years),and 51%were males(n=194).At admission,54%of the study cohort had liver injury.The pattern of liver injury was hepatocellular injury with an aspartate aminotransferase(AST)predominance.Admission AST levels were independently associated with all-cause in-hospital mortality in the logistic regression analysis.A one-fold increase in serum AST levels among patients with COVID-19 led to an eleven-fold increase in in-hospital mortality(P<0.001).Admission AST levels correlated with C-reactive protein(r=0.2;P<0.003)and serum ferritin(r=0.2;P<0.0002)levels.Admission alanine aminotransferase levels correlated with serum ferritin levels(r=0.1;P<0.04).Serum total bilirubin levels were independently associated with in-hospital mortality in the binary logistic regression analysis after adjusting for age and sex but lost its statistical significance in the fully adjusted model.Serum ferritin levels were significantly associated with in-hospital mortality(P<0.01).The probability of survival was significantly different between the AST groups and showed the following order:a two-fold increase in AST levels>a one-fold increase in in AST levels>normal AST levels(P<0.0001).CONCLUSION Liver injury with an AST-dominant pattern predicts the severity of COVID-19.Elevated serum ferritin levels are associated with fatal outcomes.

Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19

BACKGROUND Coronavirus disease 2019(COVID-19)has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system.Blood biomarkers are affordable,rapid,objective,and useful in the evaluation and prognostication of COVID-19 patients.AIM To investigate the association between aspartate transferase-to-platelet ratio index(APRI)and in-hospital mortality to develop a COVID-19 mortality prediction model.METHODS A multicenter cohort study with a retrospective design was conducted.Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital(Assiut,Egypt)and Chest Hospital(Assiut,Egypt)with confirmed COVID-19 from July 1,2020 to October 1,2020,were retrieved and analyzed.The patient cohort was classified into the following two categories based on the APRI:(1)COVID-19 presenting with APRI≤0.5;and(2)COVID-19 presenting with APRI(>0.5 and≤1.5).The association between APRI and all-cause in-hospital mortality was analyzed,and the new model was developed through logistic regression analyses.RESULTS Of the 353 patients who satisfied the inclusion criteria,10%were admitted to the intensive care unit(n=36)and 7%died during the hospital stay(n=25).The median age was 40 years and 50.7%were male.On admission,49%had aspartate transferase-dominant liver injury.On admission,APRI(>0.5 and≤1.5)was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex;after stepwise adjustment for several clinically relevant confounders,APRI was still significantly associated with all-cause inhospital mortality.On admission,APRI(>0.5 and≤1.5)increased the odds of mortality by fivetimes(P<0.006).From these results,we developed a new predictive model,the APRI-plus,which includes the four predictors of age,aspartate transferase,platelets,and serum ferritin.Performance for mortality was very good,with an area under the receiver operating curve of 0.90.CONCLUSION APRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality,independent of other relevant predictors.

Systemic autoimmune abnormalities complicated by cytomegalovirus-induced hemophagocytic lymphohistiocytosis:A case report

BACKGROUND Hemophagocytic lymphohistiocytosis(HLH)is a rare but life-threatening disorder,characterized by a hyperimmune response.The mortality is high despite progress being made in the diagnosis and treatment of the disease.HLH is traditionally divided into primary(familial or genetic)and secondary(reactive)according to the etiology.Secondary HLH(sHLH),more common in adults,is often associated with underlying conditions including severe infections,malignancies,autoimmune diseases,or other etiologies.CASE SUMMARY The case involves a 31-year-old woman,presented with a high persistent fever,rash,and splenomegaly.She met the diagnostic criteria of the HLH-2004 guideline and thus was diagnosed with HLH,with positive anti-nuclear antibody(ANA)and positive cytomegalovirus(CMV)-DNA.The patient responded well to a combination of immunomodulatory,chemotherapy,and supportive treatments.When her PCR evaluation for CMV turned negative,her serum ferritin also dropped significantly.Her clinical symptoms improved dramatically,and except for ANA,the abnormal laboratory findings associated with HLH returned to normal.Our previous study has shown that the median overall survival of HLH patients is only 6 mo;however,our patient has been cured and has not presented with any relapse of the disease for 6 years.CONCLUSION This case emphasizes that thorough early removal of the CMV infection is significant for the prognosis of this HLH patient.

Assessment of Iron Profile among Transfused Dependent Chronic Renal Failure Sudanese Patients

Background: Anemia is one of the complications of chronic kidney disease (CKD) which necessitates multiple blood transfusions. These multiple transfusions are usually accompanied by Iron over load. The current study aimed to assess the Iron profile in Sudanese patients with chronic renal failure received regular blood transfused. Materials and Methods: A descriptive analytical case control study was performed in Alturki Teaching Hospital, Khartoum, Sudan. A total of 90 Sudanese were enrolled in this study (30 CKD patients under hemodialysis and undergo multiple blood transfusion, 30 CKD patients under hemodialysis but not blood transfusion and 30 healthy controls, 51 (57%) were male and 39 (43%) were females, their age ranged between 28 to 75 years. Iron profile (serum iron, serum ferritin and total iron binding capacity (TIBC)) were measured using full automated Chemical analyzer Mindray BS 200 (China). Data were analyzed by using statistical package for social sciences (SPSS) verssion16. Results: The present study showed that serum iron and serum ferritin of those under hemodialysis and received regular blood transfusion patient were significantly higher compared to those under hemodialysis and did not received regular blood transfusion patients (P value 0.000 and 0.01) respectively. Conclusion: Patients with chronic renal failure and under hemodialysis and receive regular and multiple transfusions are prone to iron overload.

Relationship between serum ferritin and hemoglobin levels determined by cardiac and hepatic T2 MRI in beta-thalassemia intermedia and major patients

BACKGROUND： Thalassemia major is one of the most common hereditary disorders, and it causes ineffective hematopoiesis in the body through disarrangement of the hemoglobin synthesis balance. Regular blood transfusions cause complications of iron overload in the body in these patients. Tissue iron status can be determined by measuring serum and liver biopsy ferritin levels and by T2＊ MRI. This study assessed the relationship between serum ferritin and hemoglobin by T2＊ MRI of the heart and liver. METHOD： This cross-sectional descriptive study was carried out on patients with beta-thalassemia intermedia and major who visited the Center for Thalassemia and Hemoglobinopathies at Shafa Hospital, Ahwaz, between 2014 and 2015. All patients were receiving regular blood transfusions every 2-4 weeks. Pearson＇s correlation test was used to assess serum ferritin and T2＊ values from heart and liver MRI. RESULTS： A total of 260 patients （mean age is 23-year-old） were enrolled in the study. The incidence of iron overload in the liver and heart was 83% and 39%, respectively. Serum ferritin levels showed a very strong inverse correlation with T2＊ values on heart （r = -3.54, p 〈 0.0001） and liver （r = -3.03, p 〈 0.0001） MRI. Additionally, a meaningful interaction was observed between the T2＊ values from liver and heart MRI （r = 0.29, p 〈 0.0001）. CONCLUSION： Serum ferritin is strongly and inversely correlated with T2＊ values of MRI of the liver and heart in patients with thalassemia. Therefore, T2＊ MRI can be used to assess tissue iron levels with very high accuracy.

The validity of serum ferritin levels in predicting cardiovascular events of metabolic dysfunction-associated steatotic liver disease patients may need more consideration

We read with great interest the informative study by Armandi et al.,which shed light on the potential role of serum ferritin in predicting the long-term prognosis of patients with metabolic dysfunction-associated steatotic liver disease(1).However,there remain certain facets requiring in-depth investigation and interpretation.First of all,the study found that integrating stepwise increased ferritin thresholds(215.5 and 272µg/L)into predictive models can improve the performance of fibrosis-4(FIB-4)and Non-Alcoholic Fatty Liver Disease Fibrosis Score(NFS)in the longitudinal risk assessment of liver-related events and overall mortality.However,it has been suggested that metabolic hyperferritinaemia(MHF)appears to exhibit a male predominance(2,3).Since the study primarily comprised male participants(65%),it raises the query of whether the ferritin threshold based on the entire population can accurately predict risks within female patients.Therefore,a sex-specific analysis is warranted to ensure a more precise evaluation.

Clinical malaria and the potential risk of anaemia among preschool-aged children:apopulation-based study of the 2015-2016 Malawi micronutrient survey

Background:Anaemia and malaria are common and life-threatening diseases among preschool-aged children in many tropical and subtropical areas,and Malawi is no exception.Accordingly,this study aimed to examine the association of referral clinical malaria with anemia(hemoglobin[Hb]<110g/L)in preschool-aged children in Malawi.Methods:Using cross-sectional data obtained from the 2015-2016 Malawi Micronutrient Survey(MNS),multivariate logistic regression models were construaed using surveylogistic to account for the complex survey design.Blood samples of 1051 children aged 6-59 months were evaluated for malaria(using rapid diagnostic test[RDT]-SD BIOLINE Malaria Ag P.f/Pan test histidine-rich protein(HRP-Ⅱ)^™),Hb(using HemoCue 301),a-1-acid glycoprotein(AGP),and serum ferritin biomarkers(using simple sandwich enzyme-linked immunosorbent assay technique,ELISA)and inherited blood disorders from dry blood samples(DBS)using polymerize chain reaaion(PCR).Diagnosis of clinical malaria was made on the basis of fever and a positive rapid diagnostic test(RDT).Results:Of the 1051 PSC analysed,29%had anaemia while 24.4%had a referral to the hospital due to malaria.After adjustments for known confounders,PSC with a history of referral clinical malaria had increased odds of being anaemic(adjusted odds ratio[aOR]=4.63,95%confidence interval[Cf]:2.90-7.40),P<0.0001.Conclusions:This study found that clinical malaria increased the risk of anaemia in PSC Thus,elimination of malariacausing parasites from the PSCs blood should be rapid and complete in order to prevent the progression of uncomplicated malaria to a chronic infection that can lead to the development of malaria-related anaemia.