A patient treated with parenteral artesunate for severe malaria may develop a delayed hemolytic anemia, termed Postartemisinin Delayed Hemolysis or PADH.
Patient selection: severe malaria treated with parenteral artesunate (a derivative of artemisinin)
Clinical features:
(1) history of artesunate therapy
(2) delayed onset of a hemolytic anemia >= 1 week after the therapy
(3) anemia may be severe enough to require transfusion
(4) an affected patient usually recovers without long-term sequelae
As infected erythrocytes pass through the spleen the malaria parasites are removed, resulting in formation of “pitted” ertythrocytes (also referred to as “once-infected erythrocytes”). These cells still circulate but have a reduce lifespan. In a patient with a high level of parasitemia a considerable number of these pitted erythrocytes may hemolyze in a short period of time.
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