Short-term effects of vitamin A and antimalarial treatment on erythropoiesis in severely anemic Zanzibari preschool children

Sarah E. Cusick, James M Tielsch, Mahdi Ramsan, Jape K. Jape, Sunil Sazawal, Robert E. Black, Rebecca J. Stoltzfus

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: The pathophysiology of anemia in coastal East Africa is complex. Impaired erythropoietin production is one possible mechanism. Plasmodium falciparum malaria has been found to blunt erythropoietin production, whereas vitamin A stimulates erythropoietin production in vitro. Objective: We investigated the 72-h effects of vitamin A and the antimalarial drug sulfadoxine pyramethamine (SP) on erythropoietin production in severely anemic (hemoglobin ≤ 70 g/L) preschool children in Zanzibar, a region of known vitamin A deficiency. We hypothesized that both treatments would stimulate erythropoietin production directly, within 72 h, before a change in hemoglobin would occur. Design: One hundred forty-one severely anemic children were identified during the baseline assessment of a morbidity substudy of a community-based micronutrient supplementation trial. All severely anemic children were randomly assigned to receive either vitamin A (100 000 or 200 000 IU depending on age) or SP at baseline; 72 h later they received the opposite treatment plus daily hematinic syrup for 90 d. Erythropoietic and parasitic indicators were assessed at baseline and again after 72 h. Results: After 72 h, SP reduced the malaria parasite density (by 5029 parasites/μL; P < 0.001), CRP concentrations (by 10.6 mg/L; P = 0.001), and the proportion of children infected with malaria (by 32.4%; P < 0.001). Vitamin A reduced CRP (by 9.6 mg/L; P = 0.011), serum ferritin (by 18.1 μg/L; P = 0.042), and erythropoietin (by 194.7 mIU/mL; P = 0.011) concentrations and increased the reticulocyte production index (by 0.40; P = 0.041). Conclusions: Contrary to our hypothesis, vitamin A significantly decreased erythropoietin concentration. The most important effect of both vitamin A and SP was the rapid reduction of inflammation. Vitamin A also mobilized iron from stores and stimulated the production of new erythrocytes.

Original languageEnglish (US)
Pages (from-to)406-412
Number of pages7
JournalAmerican Journal of Clinical Nutrition
Issue number2
StatePublished - 2005


  • Anemia
  • Children
  • Erythropoiesis
  • Erythropoietin
  • Inflammation
  • Malaria
  • Vitamin A

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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