Spontaneous rupture of spleen during peripheral blood stem-cell mobilisation in a healthy donor
Falzetti, F.; Aversa, F.; Minelli, O.; Tabilio, A.
Lancet 353(9152): 555
1999
ISSN/ISBN: 0140-6736 PMID: 10028986 DOI: 10.1016/s0140-6736(99)00268-8Document Number: 238364
Beriberi or thiamine deficiency is common in countries where malaria is endemic. The hypotheses that subclinical thiamine deficiency complicates malaria and may be associated with lactic acidosis and coma were investigated in a prospective study conducted in Kanchanaburi, Thailand. 77 consecutive patients who presented to Paholpolpayuhasena Hospital between May and July 1992 with malaria or other febrile illnesses and 50 healthy relatives and volunteers were enrolled. The activation coefficient for transketolase activity in erythrocytes was used to measure thiamine deficiency. The mean Box-Cox transformed coefficients were 0.166 among cases with severe malaria (n = 23), 0.145 in cases with uncomplicated malaria (n = 54), 0.138 in healthy volunteers (n = 27), 0.137 in febrile controls (n = 10), and 0.122 in healthy relatives of patients (n = 13). 12 patients (52%) with severe malaria and 10 (19%) of those with uncomplicated malaria had coefficients above the normal range. Thiamine deficiency occurred in significantly more patients with cerebral malaria than in those with uncomplicated malaria (odds ratio, 4.8; 95% confidence interval, 1.68-13.8). The 12 patients who died from severe malaria had higher coefficient values than the 115 patients and controls who survived. Finally, the 15 patients with lactic acidosis had significantly higher coefficient values than those without this complication. A study of thiamine administration to patients with cerebral malaria is recommended to allow distinctions between the findings recorded in this study and the possibility of a causal link.