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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