title: Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria.
abstract: Episodes of delayed hemolysis 2-6 weeks after treatment of severe malaria with intravenous artesunate have been described. We performed a prospective observational study of patients with uncomplicated malaria to investigate whether posttreatment hemolysis also occurs after oral artemisinin-based combination therapy. Eight of 20 patients with uncomplicated malaria who were given oral artemisinin-based combination therapy met the definition of posttreatment hemolysis (low haptoglobin level and increased lactate dehydrogenase level on day 14). Five patients had hemolysis persisting for 1 month. Patients with posttreatment hemolysis had a median decrease in hemoglobin level of 1.3 g/dL (interquartile range 0.3-2.0 g/dL) in the posttreatment period, and patients without posttreatment hemolysis had a median increase of 0.3 g/dL (IQR -0.1 to 0.7 g/dL; p = 0.002). These findings indicate a need for increased vigilance for hemolytic events in malaria patients, particularly those with predisposing factors for anemia.
authors.forename: Florian
authors.initials: F
authors.lastname: Kurth
authors.forename: Tilman
authors.initials: T
authors.lastname: Lingscheid
authors.forename: Florian
authors.initials: F
authors.lastname: Steiner
authors.forename: Miriam S
authors.initials: MS
authors.lastname: Stegemann
authors.forename: Sabine
authors.initials: S
authors.lastname: Bélard
authors.forename: Nikolai
authors.initials: N
authors.lastname: Menner
authors.forename: Peter
authors.initials: P
authors.lastname: Pongratz
authors.forename: Johanna
authors.initials: J
authors.lastname: Kim
authors.forename: Horst
authors.initials: H
authors.lastname: von Bernuth
authors.forename: Beate
authors.initials: B
authors.lastname: Mayer
authors.forename: Georg
authors.initials: G
authors.lastname: Damm
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Abdulgabar
authors.initials: A
authors.lastname: Salama
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.forename: Thomas
authors.initials: T
authors.lastname: Zoller
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000139:chemically induced; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use; D010879:Piperazines
chemical_list: D000962:Antimalarials; D000077549:Artemether; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000078102:Lumefantrine; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
keywords: Plasmodium falciparum; anemia; artemisinin; clinical study; haptoglobin; hemoglobin; hemolysis; lactate dehydrogenase; malaria; oral artemisinin combination therapy; parasites; uncomplicated malaria