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Published on: July 17, 2014
Post-artemisinin delayed hemolysis after oral therapy for P. falciparum infection
Christian C Conlon1, Anna Stein1, Rhonda E Colombo1
1Madigan Army Medical Center Department of Medicine, 9040 Jackson Ave, Fort Lewis McChord, Washington, 98413, USA.
Abstract:
A documented side-effect of artemisinin therapy is post-artemisinin delayed hemolysis (PADH), primarily occurring after parenteral treatment for severe P. falciparum infections. PADH has been infrequently reported after oral therapy and is rarely severe enough to require hospitalization and blood transfusions. A 24 year old man was diagnosed with P. falciparum, prompting initiation of oral artemether-lumefantrine (AL). Further work-up demonstrated that he met WHO criteria for severe malaria infection on the basis of high parasitemia and his regimen was switched to intravenous quinidine and oral doxycycline. He was transitioned back to AL after 4 days and was discharged on hospital day six. Five days later, he was readmitted for hemolytic anemia. His peripheral blood was absent of malaria parasites and he was diagnosed with PADH, ultimately requiring multiple blood transfusions. Severe hemolytic anemia requiring blood transfusions after oral artemisinin therapy is rare and may be associated with higher parasite loads. This case demonstrates the importance of close reassessment and consideration of PADH in patients treated with oral therapies, particularly in the setting of severe malarial infections.
Insights
Post-artemisinin delayed hemolysis (PADH) is a rare but serious side effect, even after oral artemisinin treatment for severe malaria. Close patient monitoring is crucial for early detection and management of this condition.
Area of Science:
- Malariology
- Hematology
- Pharmacovigilance
Background:
- Post-artemisinin delayed hemolysis (PADH) is a known complication of artemisinin-based antimalarial drugs.
- PADH typically occurs after parenteral administration for severe Plasmodium falciparum infections.
- Severe PADH requiring hospitalization and blood transfusions after oral artemisinin therapy is exceptionally rare.
Observation:
- A 24-year-old male with severe P. falciparum malaria initially treated with oral artemether-lumefantrine (AL).
- Due to high parasitemia, treatment was switched to intravenous quinidine and doxycycline, then back to oral AL.
- The patient was readmitted five days post-discharge with severe hemolytic anemia, diagnosed as PADH, necessitating blood transfusions.
Findings:
- This case highlights a rare instance of severe PADH following oral artemisinin therapy.
- High initial parasite loads in severe malaria may be a risk factor for developing PADH, even with oral treatment.
- Absence of peripheral parasitemia at readmission confirmed PADH as the cause of hemolytic anemia.
Implications:
- Clinicians should maintain a high index of suspicion for PADH in patients treated with oral artemisinin, especially those with initially severe malaria.
- Close follow-up and reassessment are vital after completing oral artemisinin courses to detect delayed adverse events.
- This case underscores the need for vigilance regarding rare but severe side effects of antimalarial drugs, irrespective of the route of administration.
