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Blood, 15 July 2001, Vol. 98, No. 2, pp. 450-457
RED CELLS
A comparison of the in vivo kinetics of Plasmodium
falciparum ring-infected erythrocyte surface antigen-positive
and -negative erythrocytes
Paul N. Newton,
Kesinee Chotivanich,
Wirongrong Chierakul,
Ronatrai Ruangveerayuth,
Pramote Teerapong,
Kamolrat Silamut,
Sornchai Looareesuwan, and
Nicholas J. White
From the Faculty of Tropical Medicine, Mahidol
University, Bangkok, Thailand; the Centre for Tropical Medicine,
Nuffield Department of Clinical Medicine, John Radcliffe Hospital,
Oxford, United Kingdom; the Department of Medicine, Mae Sot Hospital,
Tak Province, Thailand; and the Department of Pharmacology,
Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Ring-infected erythrocyte surface antigen (RESA)-positive,
Plasmodium falciparum-negative red blood cells (RBCs) are
cells from which the malaria parasite has been removed by the host
without the destruction of the erythrocyte ("pitting"). The
survival of RESA-RBCs in vivo was assessed in 14 severe and 6 uncomplicated falciparum malaria patients. The mean RESA-RBC life of
183 hours (95% confidence interval [CI], 136-246) was longer than
the median parasite clearance time of 66 hours (range, 30-108 hours)
but shorter than the mean red cell life of 1027 hours (95% CI,
840-1213) (P = .0004), with a median ratio of 0.2:1.0
(range, 0.1-0.7). The estimated median percentage of parasites
pitted/body transit was 0.003% (range, 0.001%-0.05%). The rate of
rise of the RESA-RBC count during the first 24 hours after antimalarial
treatment was significantly faster (P = .036) and the
subsequent RESA-RBC survival significantly shorter
(P = .017) after treatment with an artemisinin derivative
than after treatment with quinine. Parasitization of red cells leads to
changes in the erythrocyte that shorten their survival even if the
parasite is removed subsequently.

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