Wickramasinghe S N, Phillips R E, Looareesuwan S, Warrell D A, Hughes M
Br J Haematol. 1987 Jul;66(3):295-306. doi: 10.1111/j.1365-2141.1987.tb06913.x.
Bone marrow aspirates from patients with cerebral malaria were studied with the light and electron microscopes. Various abnormalities were found including: (1) an increase in plasma cells and macrophages, sometimes to a marked degree; (2) phagocytosis of parasitized red cells by macrophages and of merozoites by neutrophil metamyelocytes, neutrophil granulocytes and macrophages; (3) an increase in the proportion of eosinophil granulocytes and their precursors; (4) the presence of giant metamyelocytes; and (5) morphological abnormalities of erythroblasts, particularly irregularly-shaped nuclei and karyorrhexis. A high percentage of the red cells within marrow sinusoids were parasitized and the parasitized cells were attached to the endothelium. Some marrow sinusoids were packed with and completely obstructed by parasitized cells. Strands of electron-dense material were sometimes found connecting the knobs of parasitized red cells to endothelial cells or to the knobs of adjacent parasitized red cells. A striking finding was a complex interdigitation between cytoplasmic processes developed by some of the parasitized red cells and those developed by the endothelial cells to which they were attached. Occasionally, cytoplasmic processes arising from marginated parasitized red cells completely penetrated the endothelial cell and emerged extravascularly. Several parasitized red cells were also found extravascularly between haemopoietic cells. Sequestration of parasitized red cells within small blood vessels may play a part in the pathogenesis not only of the encephalopathy of cerebral malaria but also of the bone marrow dysfunction in severe malaria.
对脑型疟疾患者的骨髓穿刺物进行了光镜和电镜研究。发现了各种异常情况，包括：（1）浆细胞和巨噬细胞增多，有时程度明显；（2）巨噬细胞吞噬被寄生的红细胞，中性晚幼粒细胞、中性粒细胞和巨噬细胞吞噬裂殖子；（3）嗜酸性粒细胞及其前体的比例增加；（4）出现巨大晚幼粒细胞；（5）成红细胞形态异常，特别是细胞核形状不规则和核溶解。骨髓血窦内高比例的红细胞被寄生，且被寄生的细胞附着于内皮细胞。一些骨髓血窦被被寄生的细胞挤满并完全阻塞。有时发现电子致密物质的条索将被寄生红细胞的瘤状物与内皮细胞或相邻被寄生红细胞的瘤状物相连。一个显著的发现是，一些被寄生红细胞形成的细胞质突起与它们所附着的内皮细胞形成的细胞质突起之间存在复杂的相互交错。偶尔，边缘被寄生红细胞产生的细胞质突起会完全穿透内皮细胞并出现在血管外。在造血细胞之间的血管外也发现了几个被寄生的红细胞。被寄生红细胞在小血管内的滞留可能不仅在脑型疟疾的脑病发病机制中起作用，而且在重症疟疾的骨髓功能障碍中也起作用。
