Plasmodium spp. parasitize the red blood cells, which are metabolized during the schizogonic cycle, leaving  pigment granules. Reticular and endothelial cells phagocytize red blood cell fragments and accumulate malarial pigment. P. vivax and P. ovale predominantly infect the relatively scarce young red blood cells, thus restricting the level of parasitemia. P. falciparum and P. malariae infect mature cells a few or many of which may be infected, often resulting in anemia. Red blood cells parasitized with P. falciparum are sequestrated in capillaries of internal organs by  knobs on their surface reacting with receptors on the vascular endothelium, thereby causing  tissue anoxia This is particularly serious in the brain  Pathology/Fig. 15 ), where endothelial cells die and capillaries break, giving rise to multiple petechial hemorrhages. Brain anoxia leads to edema and coma, which may be fatal in a few hours. Occasionally glial reactions are seen in response to microinfarcts.

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