Delayed haemolysis secondary to treatment of severe malaria with intravenous artesunate: Report on the experience of a referral centre for tropical infections in Spain.
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.
Microbiology and Infectious Diseases Service, Gregorio Marañon Hospital, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain. Electronic address: teresaldamiz@yahoo.es.
Teresa
T
Aldámiz-Echevarría Lois
National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: ana.lopez-polin@salud.madrid.org.
Ana
A
López-Polín
National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: ffnorman@gmail.com.
Francesca F
FF
Norman
National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: begomongem@gmail.com.
Begoña
B
Monge-Maillo
National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: rogelio.lopezvelez@salud.madrid.org.
Rogelio
R
López-Vélez
National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: jperezm@salud.madrid.org.
Jose A
JA
Perez-Molina
D061605:Administration, Intravenous; D000328:Adult; D000743:Anemia, Hemolytic / Q000139:chemically induced*; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects*; D000077332:Artesunate; D005260:Female; D006461:Hemolysis; D006760:Hospitalization; D006801:Humans; D008288:Malaria / Q000150:complications* / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain; D014195:Travel
D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate
Artemisinins; Artesunate; Complications; Haemolysis; Malaria