Delayed haemolysis after treatment with intravenous artesunate in patients with severe malaria in India

• Main Authors: Deepali Savargaonkar, Manoj Kumar Das, Amar Verma, Jeevan K. Mitra, C. P. Yadav, Bina Srivastava, Anupkumar R. Anvikar, Neena Valecha
• Format: Article
• Language: English
• Published: BMC 2020-01-01
• Series: Malaria Journal
• Subjects: Severe malaria; Injection artesunate; Delayed haemolysis; Haemoglobin; Lactate dehydrogenase
• Online Access: https://doi.org/10.1186/s12936-020-3120-4

Abstract Background Parenteral artesunate is the treatment of choice for severe malaria. It is safe, efficacious and well tolerated anti-malarial. However, delayed haemolysis has been reported in travellers, non-immune individuals and in African children. Methods A prospective, observational study was carried out in admitted severe malaria patients receiving parenteral artesunate. The patients were followed up until day 28 for monitoring clinical as well as laboratory parameters for haemolytic anaemia. Results Twenty-four patients with severe malaria receiving injection artesunate were enrolled in the study. Post-artesunate delayed haemolysis following parenteral artesunate therapy was observed in three of 24 patients (12.5%, 95% confidence interval 4.5–31.2%). Haemolysis was observed in two more patients possibly due to other reasons. The haemoglobin fall ranged from 13.6 to 38.3% from day 7 to day 28 in these patients. Conclusion The possibility of delayed haemolysis should be considered while treating the severe malaria patients with parenteral artesunate. The study highlights the need for further studies in different epidemiological settings.