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Volume 21, Number 5—May 2015
Research

Delayed-Onset Hemolytic Anemia in Patients with Travel-Associated Severe Malaria Treated with Artesunate, France, 2011–2013

Stéphane JauréguiberryComments to Author , Marc Thellier, Papa Alioune Ndour, Flavie Ader, Camille Roussel, Romain Sonneville, Julien Mayaux, Sophie Matheron, Adela Angoulvant, Benjamin Wyplosz, Christophe Rapp, Thierry Pistone, Bénédicte Lebrun-Vignes, Eric Kendjo, Martin Danis, Sandrine Houzé, François Bricaire, Dominique Mazier, Pierre Buffet, Eric Caumes, and French Artesunate Working Group
Author affiliations: Université Pierre et Marie Curie, Paris, France (S. Jauréguiberry, M. Thellier, P.A. Ndour, C. Roussel, M. Danis, D. Mazier, P. Buffet, E. Caumes); Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Paris (S. Jauréguiberry, M. Thellier, F. Ader, J. Mayaux, B. Lebrun-Vignes, M. Danis, F. Bricaire, D. Mazier, P. Buffet, E. Caumes); Centre National de Référence du Paludisme, Paris (S. Jauréguiberry, M. Thellier, E. Kendjo, M. Danis, D. Mazier, P. Buffet); Hôpital Bichat, APHP, Paris (R. Sonneville, S. Matheron, S. Houzé); Université Paris-Sud, Orsay, France (A. Angoulvant); Hôpital de Bicêtre, Le Kremlin Bicêtre, APHP, France (A. Angoulvant, B. Wyplosz); Hôpital d’Instruction des Armées Begin, St. Mandé, France (C. Rapp); Hôpital Pellegrin, Bordeaux, France (T. Pistone)

Main Article

Table 3

Laboratory values for 72 patients with artesunate-treated severe imported malaria and a PADH or non-PADH pattern of anemia during days 0–28 after treatment initiation, France, 2011–2013*

Patient group, laboratory test Median value (range), no. results available
Day 0 Day 7 Day 14 Day 21 Day 28
Non-PADH†
Hemoglobin level, g/dL‡ 11.3 (5.9–16.6), 51 9.2 (5.7–13.1), 
62 9.9 (6.2–14.3), 
32 10.6 (7.7–13.0), 22 11.5 (8.2–13.9), 30
Reticulocyte count, G/L 61 (3–183), 16 60 (2–444), 25 156 (75–412), 20 108 (56–204), 12 73 (34–100), 12
LDH level, IU/L 777 (161–3,003), 24 803 (312–2,722), 28 537 (261–1,139), 17 521 (201–905), 
12 464 (240–798), 
15
Haptoglobin level, g/L
 0.05 (0.00–2.20), 8
 0 (0.00–2.90), 
25
 0 (0.00–2.50), 
20
 0 (0.00–2.00), 
10
 0.40 (0.00–1.40), 12
PADH§
Hemoglobin level, g/dL¶ 13.6 (9.4–16.0), 21 11.2 (6.2–14.2), 20 9.9 (4.6–12.9), 
24 10.0 (6.7–13.4), 15 11.1 (10–15), 
17
Reticulocyte count, G/L 61 (61–61), 1 34 (8–132), 12 124 (63–315), 15 162 (90–431), 12 127 (63–223), 13
LDH level, IU/L 846 (293–1,195), 9 634 (510–793), 
14 1,128 (554–4,000), 17 724 (344–1,564), 13 497 (177–922), 
14
Haptoglobin level, g/L 0 (0.00–0.20), 5 0 (0.00–1.50), 15 0 (0.00–0.60), 18 0 (0.00–0.00), 13 0 (0.00–1.50), 15

*G/L, Giga/L; LDH, lactate dehydrogenase; PADH, postartesunate delayed-onset hemolysis.
†Non-PADH pattern was defined by a hemoglobin nadir and a hemolysis peak occurring before day 8, with or without positive markers of hemolysis after day 8 and without a nadir or sudden drop of hemoglobin after day 8.
‡Median drop in hemoglobin during the first week of treatment was 2.1 g/dL.
§PADH pattern was defined by 1) a new drop in the hemoglobin level after day 8 of treatment initiation and the appearance or reappearance of hemolytic markers (defined as >10% drop in hemoglobin or >10% rise in LDH levels) occurring any time between day 8 and the end of follow-up and/or 2) by any information in the medical chart referring to acute hemolysis occurring after day 8.
¶Median drop in hemoglobin during the first week of treatment was 2.4 g/dL.

Main Article

1Members of the French Artesunate Working Group are listed in the Technical Appendix.

Page created: April 17, 2015
Page updated: April 17, 2015
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