Background and importance Intravenous artesunate is the main therapy for severe malaria. Overall it is a well-tolerated treatment but, in some cases, could lead to a post-artesunate-induced haemolysis (PAIH), which could be a serious late complication that courses with acute anaemia.
Aim and objectives To assess the frequency of PAIH in patients treated with artesunate for severe malaria.
Material and methods Retrospective observational study from September 2015 to September 2021. All patients that were diagnosed with severe malaria and treated with intravenous artesunate were included. Data collected: demographic, mean parasitaemia: before/after artesunate, mean dose of artesunate administered, biochemical parameters represented as mean with standard deviation (±SD): lactate dehydrogenase (LDH), haemoglobin (Hb), total bilirubin (TB). Biochemical parameters were collected at the moment of hospitalisation, prior to discharge, 2 weeks and 1 month after discharge. Anaemia severity: mild (10–12 mg/dL), moderate (8–10 mg/dL), severe (<8 mg/dL). Data were collected from the digital clinical history. A significative Hb drop from the baseline compatible with hemolysis started after discharge, and with no other clinical explanation was considered to be PAIH.
Results 47 patients included, 95% men, mean age: 38 years, range: 21–59 years, parasitaemia before artesunate: 6%, after artesunate: 0.5%. Mean artesunate dose 480 mg. Biochemical parameters at the moment of hospitalisation: LDH: 372±115 U/L, Hb: 13±2 g/dL, TB: 2.82±3.78 mg/dL. Prior to discharge: LDH: 326±113 U/L, Hb: 11.5±1.5 g/dL, TB: 1.03±1.05 mg/dL. Two weeks after discharge: LDH: 302±90.5 U/L Hb: 12±1.3 g/dL, TB: 1.2±1.8 mg/dL. A month after discharge: LDH: 240±80 U/L, Hb: 13±3 g/dL, TB: 0.8±0.6 mg/dL. 24 (51%) patients had anaemia in the moment of discharge. 19 (40%) still had anaemia 2 weeks after discharge and 10 (21%) a month after discharge. 11 (23%) patients experimented a Hb drop compatible with PAIH, of which 8 (17%) were detected 2 weeks after discharge,though none of them were severe. Anaemia was mild in every case.
Conclusion and relevance PAIH is a relatively common event that in most cases is asymptomatic and does not require medical intervention, and this may lead to it being an underdiagnosed event. Most PAIH cases are detected in the first month after hospitalisation. Hb should be monitored after discharge in every patient that receives artesunate in order to prevent a possible severe PAIH event.
Conflict of interest No conflict of interest
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