lumefantrine and Hemolysis

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.

Topics: Administration, Oral; Adolescent; Adult; Anemia; Antimalarials; Artemether; Artemisinins; Child; Drug Therapy, Combination; Ethanolamines; Female; Fluorenes; Hemolysis; Humans; Lumefantrine; Malaria, Falciparum; Male; Prospective Studies; Quinolines

Topics: Adult; Antimalarials; Artemether; Artemisinins; Blood Transfusion; Doxycycline; Ethanolamines; Fluorenes; Hemolysis; Humans; Lumefantrine; Malaria; Malaysia; Male; Mefloquine; Microscopy; Phylogeny; Plasmodium knowlesi; Polymerase Chain Reaction; Protozoan Proteins; Quinine; Recurrence