TOP 56 - Anemia Risk and Hepatic Fibrosis in the Context of Schistosoma japonicum Infection

Publication Number: 1815.TOP 56

Kirsten d'Hemecourt, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Mario Antonio L. Jiz, RITM, Muntinlupa City, National Capital Region, Philippines; Hannah Wu, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Ralph N. Aniceto, Research Institute for Tropical Medicine, Tacloban, Leyte, Philippines; Jennifer Friedman, The Warren Alpert Medical School of Brown University, Providence, RI, United States

Background: Schistosomiasis is a neglected tropical disease affecting over 200 million people worldwide. Complications of intestinal Schistosoma japonicum infection include anemia and hepatic fibrosis, yet the relationship between these key morbidities is poorly understood. Anemia may arise from iron loss through intestinal bleeding or from chronic inflammation related to immune responses. Hepatic egg deposition induces inflammation and fibrosis, suggesting that resolution of liver pathology after treatment could also improve anemia of inflammation. However, the extent to which hepatic fibrosis and related inflammation contribute to anemia remains unclear. Improved understanding of the anemia–fibrosis relationship could clarify disease pathophysiology and inform management strategies for affected populations.

Objective: To characterize the prevalence, type, and severity of anemia in individuals with S. japonicum infection, and to assess how anemia relates to hepatic fibrosis and its progression. The primary objective is to evaluate the cross-sectional association between anemia type/severity and fibrosis grade at baseline. The secondary objective is to examine the longitudinal relationship between anemia and hepatic fibrosis.

Design/Methods: This is a secondary data analysis that leverages an NIH-funded Tropical Medicine Research Centers (TMRC) cohort in Leyte, The Philippines. The cohort includes ~950 participants aged 14–60 years with confirmed infection, of whom ~300 with hepatic fibrosis were followed longitudinally after treatment. Data from one year of follow up for the whole cohort is available. Individuals with significant comorbid illness, non-schistosomiasis-related fibrosis, or inability to provide consent were excluded.

Anemia type is derived using measures of hemoglobin and ferritin. Iron deficiency anemia was defined as hemoglobin < 11.0 g/dL and ferritin ≤ 30 ng/mL using WHO cut-offs. Non-iron deficiency anemia (NIDA) was defined as hemoglobin < 11.0 g/dL and ferritin > 30 ng/mL. No anemia was defined as hemoglobin ≥ 11.0 g/dL. Hepatic fibrosis is assessed and graded using standardized ultrasonography based on the WHO Niamey protocol. The primary outcome of interest is anemia and the secondary outcome is NIDA, most commonly due to anemia of inflammation in this setting. The key exposure variable is grade of hepatic fibrosis. Analyses will examine associations between fibrosis severity and anemia type/severity at baseline, and changes in anemia status in relation to fibrosis progression or regression longitudinally. This study has IRB approval.