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Microscopic slide of warm autoimmune hemolytic anemia
1 Sep 2017

Hemolytic anemia, malaria and Artesunate

Is there a certain patient population at risk for developing hemolytic anemia? In what I’ve read- hemolytic anemia seemed to be the result of dead parasites getting expelled from infected erythrocytes (pitting) in Malaria cases. Have you seen hemolytic anemia in cases in patients who haven’t had Malaria? If so, what did a treatment of the hemolytic anemia look like in those cases? Did it require blood transfusions, or were iron IVs enough to correct? From what I’ve also read (in cases of Malaria using Artesunate) the hemolytic anemia required blood transfusions. Thank you.

Dr Anderson:

Great question.
I have only heard of hemolytic anemia(HA) and Artesunate in infectious disease as you say, and mostly in RBC parasites like Malaria (makes a lot of sense.)

In over 10,000 Artesunate administrations in my career, I have never seen HA or even a sign of it.
Prevention strategies include Quantitative G6PD and not administering Artesunate to those with low Quant G6Pd. Cautions in folks with Sickle cell trait / Thalassemia minor and likely not administering in Sickle cell disease or Thalassemia Major (for “”B” and 3 or 4 gene positive “A” forms of Thal.)

For a great review of HA monitoring and treatment:
https://www.nhlbi.nih.gov/health/health-topics/topics/ha/treatment

The only thing we do monitor (usually Q 4-6 weeks) is the CBC as in some folks Artesunate can lower the RBC or the H&H. But that is not a common short term.

I hope this helps,
Dr. Anderson