Delayed haemolysis secondary to treatment of severe malaria with intravenous artesunate: Report on the experience of a referral centre for tropical infections in Spain

• Published in: Travel medicine and infectious disease 2017-01, Vol.15, p.52-56
• Main Authors: Aldámiz-Echevarría Lois, Teresa, López-Polín, Ana, Norman, Francesca F, Monge-Maillo, Begoña, López-Vélez, Rogelio, Pérez-Molina, Jose Antonio
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adult; Anemia; Anemia, Hemolytic - chemically induced; Antimalarials - administration & dosage; Antimalarials - adverse effects; Artemisinins; Artemisinins - administration & dosage; Artemisinins - adverse effects; Artesunate; Complications; Conflicts of interest; Consciousness; Drug dosages; Erythrocytes; Female; Haemolysis; Hemolysis; Hospitalization; Humans; Hypoglycemia; Infectious Disease; Malaria; Malaria - complications; Malaria - drug therapy; Malaria - parasitology; Male; Middle Aged; Mortality; Parasites; Patients; Referral and Consultation - statistics & numerical data; Retrospective Studies; Spain; Travel; Travel medicine; Tropical diseases; Vector-borne diseases
• ISSN: 1477-8939; 1873-0442
• DOI: 10.1016/j.tmaid.2016.10.013

Abstract Background Post-artesunate delayed haemolysis is described as hemolytic anemia presenting days after malaria treatment in hyperparasitemic patients. Physiopathological mechanisms and clinical manifestations have not been thoroughly characterised. Methods We conducted a retrospective study of hospitalised malaria patients who received artemisinin derivatives from January 1, 2010 to December 31, 2015. Results 21 patients were included in the study: 11 travellers, 8 travellers visiting friends and relatives and 2 immigrants. Median age was 35.5 years (IQR: 25.7–44.8) and 11 were men. Eight patients received oral and 13 received intravenous (IV) artemisinin-based drugs. Follow-up after the malaria episode was available for 15 patients (12 with IV treatment). Four patients presented with delayed haemolysis 9–14 days after artesunate treatment; all had been admitted with severe malaria, were treated IV and had hyperparasitaemia (17%–33%). Other than hyperparasitaemia, no other factors were associated with artesunate haemolysis. Patients' outcomes were favourable and the only additional therapeutic measure needed was a blood transfusion. Conclusions Delayed haemolysis is a frequent complication in hyperparasitemic malaria treated with IV artesunate. Follow-up is mandatory for at least 2 weeks after treatment initiation. This condition is potentially severe but does not appear to be life threatening.