Hemolysis is most sever with Plasmodium falciparum infection compared to other malarial parasites because of-
falciparum infection This is the most dangerous of the malarias. The onset is often insidious, with malaise, headache and vomiting. Cough and mild diarrhoea are also common. The fever has no paicular pattern. Jaundice is common due to haemolysis and hepatic dysfunction. The liver and spleen enlarge and may become tender. Anaemia as it effects all stages of rbcs leading to severe haemolysis develops rapidly, as does thrombocytopenia. A patient with falciparum malaria, apparently not seriously ill, may rapidly develop dangerous complications . Cerebral malaria is manifested by delirium, seizures or coma, usually without localising signs. Children die rapidly without any specific symptoms other than fever. Immunity is impaired in pregnancy and the parasite can preferentially bind to the placental protein chondroitin sulphate A. Aboion and intrauterine growth retardation from parasitisation of the maternal side of the placenta are frequent. Previous splenectomy increase the risk of severe malaria. Ref Harrison20th edition pg 1056
Infection
Associated gram-negative bacteremia
Ability of the parasite to infect RBCs of all ages
Ability of the organism to infect selectively reticulocytes
Ability of the organism to escape the immune recognition by the immune system
Ability of the parasite to infect RBCs of all ages