title: Delayed haemolysis after artesunate treatment of severe malaria - review of the literature and perspective.
abstract: Artesunate has replaced quinine as the recommended first-line treatment of severe malaria as it clears parasites faster and lowers mortality. After artesunate's introduction, however, reports of delayed haemolysis have emerged. Typically, this adverse haemolytic event peaks two to three weeks after the acute phase of malaria, and can be severe enough to make blood transfusions necessary in the management of some patients. Delayed haemolysis has been detected in prospective studies in 7-21% of patients treated with artesunate. A confirmed risk factor in travellers is hyperparasitaemia, while additional in malaria-endemic countries young age has been shown to increase risk. The pathophysiology of this phenomenon has not yet been fully elucidated, but may include various combinations of delayed destruction of "pitted" erythrocytes and autoimmune aetiology. All patients treated with parenteral artesunate should be followed up for at least four weeks to detect signs of haemolysis and to allow appropriate symptomatic treatment.
authors: Department of Internal Medicine, Section Tropical Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany. Electronic address: t.rolling@uke.de.
authors: Thierry
authors: T
authors: Rolling
authors: School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors: Tsiri
authors: T
authors: Agbenyega
authors: Institute for Infection and Immunity, St George's, University of London, London SW17 0RE, United Kingdom; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institute of Tropical Medicine, University Medical Centre Tübingen, Tübingen, Germany.
authors: Sanjeev
authors: S
authors: Krishna
authors: Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institute of Tropical Medicine, University Medical Centre Tübingen, Tübingen, Germany.
authors: Peter G
authors: PG
authors: Kremsner
authors: Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors: Jakob P
authors: JP
authors: Cramer
mesh_terms: D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use*; D037621:Artemisinins / Q000009:adverse effects* / Q000627:therapeutic use*; D000077332:Artesunate; D006461:Hemolysis; D006801:Humans; D008288:Malaria / Q000188:drug therapy*
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate
keywords: Artemisinins; Artesunate; Delayed haemolysis; Severe malaria