Anemia and transfusion requirements among Ugandan children with severe malaria treated with intravenous artesunate.

Abstract

Parenteral artesunate for the treatment of severe malaria in non-immune travelers is associated with late-onset hemolysis. In children in sub-Saharan Africa, the hematologic effects of malaria and artesunate are less well documented. Here we report a prospective case series of 91 children with severe malaria treated with parenteral artesunate, managed at a resource-poor hospital in Africa, with longitudinal data on hemoglobin (Hb), lactate dehydrogenase (LDH), haptoglobin, and erythrocyte morphology. The median (range) age was 2 (1-8) years and 43 (47%) were female. The median (IQR) admission Hb level was 69 (55-78) g/L and 20 patients (22%) had severe malarial anemia (Hb < 50 g/L). During hospitalization, 69 patients (76%) received one or more blood transfusions. Fatal outcome in 8 patients was associated with severe anemia in 6/8 cases. Follow-up Hb measurement was performed on 35 patients (38%) at day 14 after initial hospital admission; the remaining patients had no clinical evidence of anemia at the follow-up visit. The convalescent Hb was median (range) 90 (60-138) g/L, which was significantly higher than the paired admission levels (median increase +28 g/L, p < .001). Evidence of hemolysis (elevated LDH and low haptoglobin) was common at admission and improved by day 14. No patient met the standardized definition of post-artemisinin delayed hemolysis (PADH). In this cohort of young children with severe malaria treated with artesunate, anemia was common at admission, required one or more transfusions in a majority of patients, and markers of hemolysis had normalized by day 14.

• Authors: Michael T Hawkes, Robert O Opoka, Andrea L Conroy, Robyn E Elphinstone, Heather A Hume, Sophie Namasopo, Kevin C Kain
• Journal: Pediatric hematology and oncology (Pediatr Hematol Oncol) Vol. 37 Issue 2 Pg. 140-152 (Mar 2020) ISSN: 1521-0669 [Electronic] England
• PMID: 31826697 (Publication Type: Journal Article)

Chemical References

• Artesunate

Topics

• Administration, Intravenous
• Anemia (drug therapy)
• Artesunate (pharmacology, therapeutic use)
• Blood Transfusion (methods)
• Child
• Child, Preschool
• Female
• Humans
• Malaria
• Male
• Prospective Studies
• Uganda