Post-Artesunate Delayed Hemolysis: A Review of Current Evidence

Tropical Medicine and Infectious Disease

article

Sawettachai Jaita¹  Krit Madsalae²  Sakarn Charoensakulchai³  Borimas Hanboonkunapakarn⁴  Kesinee Chotivanit⁴  Anne E. McCarthy⁶  Wasin Matsee¹ 

[1] Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University;Chulabhorn Hospital, Chulabhorn Royal Academy;Department of Parasitology, Phramongkutklao College of Medicine;Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University;The Academy of Science, The Royal Society of Thailand;Department of Medicine, Faculty of Medicine, University of Ottawa

关键词: malaria;    post-artesunate delayed hemolysis;    artesunate;    hemolysis;    anemia;    treatment;   

DOI  :  10.3390/tropicalmed8010049

学科分类：社会科学、人文和艺术（综合）

来源: mdpi

【 摘 要 】

Artesunate is the drug of choice for treating patients with severe malaria. Post-artesunate delayed hemolysis (PADH) is an uncommon adverse event from malaria treatment. Most patients with PADH are non-immune travelers. The pathophysiology of PADH is not fully understood, but the most likely mechanism is “pitting”, in which red blood cells carrying dead parasites killed by artesunate’s action are directed to the spleen for clearing the dead parasites. After the cleansing process, these red blood cells re-enter the circulation but with a smaller size and impaired integrity, resulting in a shortened lifespan of 7–21 days. Therefore, most patients with PADH usually present with clinical features of hemolytic anemia 7 days or later after the initiation of artesunate. To date, the benefits of artesunate treatment outweigh its adverse events, and no fatal cases have resulted from PADH. However, the hematological follow-up of patients with malaria treated with artesunate is recommended for clinicians to detect any delayed hemolytic event early and prevent potentially serious consequences.

【 授权许可】

CC BY