EVALUATION OF SOME CYTOKINES AND IRON LEVELS IN PREGNANT AND POST PARTUM WOMEN WITH MALARIA PARASITAEMIA IN ABA NIGERIA

1.1INTRODUCTION

The term pregnancy refers to a state in which fertilized ovum implants into the maternal uterus and develops into a foetus.The period of development and growth of the foetus is known as gestation. During gestation, normal physiological processes such as changes in the cytokine profile, increased erythropoiesis and thrombocytopenia take place in the maternal subjects. Often, most of these processes become pathological and may complicate or threaten the well-being and survival of the mother, the foetus or both. These conditions include cytokine dysregulation, inflammation and anaemia. Other abnormal conditions may include thrombosis and disseminated intravascular coagulation (DIC) (Hoffbrand and Moss, 2011).It appears to me that of all the haematologic and immunologic conditions, anaemia appears to be the most frequently discussed.

Several factors are known to cause anaemia in pregnancy especially in sub-Saharan Africa. In this region, most factorsinteract to play significant roles in determining the severity of anaemia (Buseri et al.,2008).The incriminating factors are microbial infections, nutritional deficiencies and inherited or acquired conditions that affect the red blood cell production or destruction (WHO, 2007; Buseri et al.,2008). Infections include malaria, human immuno- deficiency virus, tuberculosis and hookworm while nutritional deficiencies include iron, folate, copper, zinc, vitamin B12 possibly riboflavin and other micronutrient deficiencies (Guyatt and Snow, 2001).

Malaria and Iron deficiency are the predominant causes of severe anaemia in sub- Saharan Africa and have their respective deleterious impacts on women of reproductive age, the neonates, infants and children(Nyakeriga et al.,2005). The vulnerability of children and pregnant women to malaria is because children have naive immune system while the immune

systems of pregnant women are potentially compromised. Consequently, the two groups are considered to be the highest risk population for malaria-related death (WHO. 2000; Laishram et al.,2012).Malaria isa known protozoandisease, transmitted to humans by infected female anopheles mosquito (Inigo and Manual, 2002). Four species of plasmodium have been emphazied as the causative agentsof malaria.However, the fifth specie known as P. knowlesi has been reported(Autino et al.,2012).Each year, about 250 million people worldwide suffer from malaria with an estimated death of about 1 million and this occurs mostly in the tropical and sub-tropical areas especially in Africa, Asia, Central and South America (Warren, 2010). It is also reported that malaria affects more than 3 million pregnant women every year in the developing countries (Abrams et al.,2005).Malaria parasite induces the activationof the cellsof the innate and adaptiveimmune response (Warren, 2010). In the maternal blood,malaria parasites elicit immune response by stimulating the immune cells such as the monocytes or macrophages,natural killer cells andhelper T-cells. These cells in the process secrete cytokine molecules (Elgert,2009). Different cytokines induce various transcription factors which in turn determine the fate of cells; either for proliferation, differentiation and survival or death (Quesenberry, 1995)

Ironis absorbed in the gastrointestinal tract and is essential for erythropoesis. In most cases, the amount of iron absorbed is not always enough for sustainance of pregnacy and may result in iron deficiency. The major reason for iron deficiency during pregnancy is that pregnancy places tremendous increase in the body‟s need for iron in other to match with the increase in plasma volume of the pregnant woman and the foetal needs for proper development (Bothwell, 2000).The need culminates in depleted iron stores. The progressive depletion of iron stores will eventually result in Iron Deficiency Anaemia (IDA) (Dreyfuss et al.,2000).

Body iron status is usually assessed by consideringHaemoglobin, red cell indicies and serum ferritin concentrations along with evidence of inflammation, infection and liver disease (Worwood and May, 2012). The assessment emphasizes onthe combination of parameters fromthe storage, transport and functional Iron compartments. The best combination would be estimations of haemoglobin or haematocrit, serum transferrin receptor and serum ferritin. Such a combination would reflect functional impairment, tissue avidity for iron and iron storage (WHO, 2001).Interestingly, cytokine and iron modulate the activities of each other.The mechanism whereby some cytokines for instance Interferon gamma (IFNg), Interleukin - 6(IL-6), Tumor Necrois Factor alpha (TNFα), Interleukin 12(IL-12), and Interleukin 13(IL-13) regulate iron homeostasis is by affecting the expression of proteins involved in thestorage and release of iron (Ludwiczek et al.,2003).Furthermore, cytokines released during infection/ inflammation such as malaria parasitaemia induces impairmentin the normal physiological mechanism for transporting iron to target tissues and this appears to be mediated by Hepcidin (WHO, 2004)

This study tends to evaluate the levels of some cytokines and iron and their activitiesin pregnant and post-partum womenwith malaria parasitaemia in Aba, Abia State.