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Table 6 Haemolysis in 7 hospitalized malaria patients receiving IV artesunate treatment

From: Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium

Patient (gender, age) Severe malaria
criteria
Anti-malarial treatment PCT
(days)*
Hb nadir(days)* Additional
diagnostics
Treatment for haemolysis
Late onset hemolysis
1 (♂, 53y) Hyperparasitaemia (34%), impaired consciousness, jaundice Q
AS (2 doses)
AP
AET
4 4.3 (D20) Coombs: C3d+ None
4 (♀, 50y) Hyperparasitaemia (19%), impaired consciousness, jaundice, acidosis, hyperlactaemia, renal impairment AS (4 doses)
AP
MET
3 4.4 (D30) Multiple in the context of an unexplained neurological disorder; coombs not performed None
38 (♀, 50y) Hyperparasitaemia(11%), jaundice AS (4 doses)
AP
3 2.8 (D13) Coombs: neg; G6PD deficient (heterozygous); Shigellaflexneri dysentery Transfusion(4 PC)
55 (♀, 44y) Hyperparasitaemia
(37%)
Q
AS (3 doses)
AL
4 3.8 (D15) Coombs: IgG +, C3d+ Transfusion(2 × 3 PC)
Steroids
58 (♂, 5y) Hyperparasitaemia (12%), impaired consciousness, shock Q
AS (doses)
AL
4(FCT 10 d) 3.8 (D8) Coombs: neg; hemoculture - None
59 (♀, 50y) Hyperparasitaemia (30%), hemoglobinuria, jaundice AS (doses)
AL
10
(FCT 17 d)
4.3 (D13) Coombs: IgG+, IgM+,
hemoculture -
G6PD: normal
Transfusion (2 PC) Steroids
Persistent hemolysis
28 (♂, 71y) Hyperparasitaemia (20%), impaired consciousness, respiratory distress, acidosis, hypoglycaemia, hyperlactaemia, renal impairment Q
AS (doses)
AL
AET
7 3.7 (D13) Coombs: neg Transfusion (7 times, total of 24 PC)
  1. Q: quinine, AS: artesunate, AP: atovaquone-proguanil AL: artemether-lumefantrine, AET: automated exchange transfusion, MET: manual exchange transfusion, PCT: parasite clearance time; FCT: fever clearance time; neg: negative; G6PD: glucose-6-phosphate dehydrogenase; HC: hemoculture; PC: packed red cells; CS: corticosteroids
  2. * number of days after 1st artesunate gift
  3. Parasitological examination was not performed between day 3 and 6 after first artesunate gift. On day 7, malaria slides were negative
  4. Hospital stay was complicated with disorientation for which patient was treated with haloperidol. Patient left the hospital against medical advice on Day 5 while not recovered fully. Within 4 weeks she was readmitted with an overt status epilepticus and fever. Diazepam, propofol and phenytoin were given after which the epileptic activity ceased. She was intubated and mechanically ventilated for 3 days. An extensive search for infectious (malaria, Epstein-Barrvirus, cytomegalovirus, Herpes simplex virus, Varicella zoster virus, enterovirus, parechovirus) and metabolic causes remained negative. Cerebrospinal fluid culture was negative. MRI of the brain showed diffuse cortical edema and no other abnormalities. She was treated with methylprednisolone after which she started to recover