The variation in in vitro binding ability to CD36 and ICAM-1, the ability to form rosettes and in PfEMP1-DBLα sequences among clinical isolates might be due to (i) severe malaria includes a variety of clinical syndromes e.g. severe anaemia, cerebral malaria, respiratory distress, which may have different underlying pathogenic mechanisms [58], (ii) the tested clinical isolates originated from different geographical malaria endemic areas (iii) the PfEMP1-DBLα sequence groups which showed association with rosette phenotype were different among isolates of different geographic areas. Here, ICAM1 is linked to anemia.