Fatal case of delayed-onset haemolytic anaemia after oral artemether-lumefantrine.
Zhang, Yimeng
Zhang, Yimeng
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Affiliation
Sandwell and West Birmingham NHS Trust
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Publication date
2021-11-19
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Abstract
Artemisinin derivatives are used globally in the management of falciparum malaria. Postartemisinin delayed haemolysis (PADH) is a recognised adverse event contributing to severe anaemia. To the best of our knowledge, we report the first recorded fatal case of PADH. A 60-year-old woman presented with two episodes of collapse at home and feeling generally unwell. She had recently been treated for uncomplicated falciparum malaria 1 month prior with artemether 80 mg/lumefantrine 480 mg in Congo. Her results on admission revealed an anaemia (haemoglobin 43 g/L), raised lactate dehydrogenase and positive direct antiglobulin test that suggested an intravascular haemolytic process. She made a capacitous decision to refuse blood products in line with her personal beliefs. Despite best supportive treatment, she did not survive. This case highlights the importance of postartemisinin follow-up and should encourage discussion and careful consideration of its use in the context of lack of access to/patient refusal of blood products.
Citation
Gustafsson L, James S, Zhang Y, Thozhuthumparambil KP. Fatal case of delayed-onset haemolytic anaemia after oral artemether-lumefantrine. BMJ Case Rep. 2021 Nov 19;14(11):e245718.
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Article