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Delayed haemolysis following artesunate in a child with profound anaemia and Coca-Cola-coloured urine.

Neaha PatelJulia ThomsonLucia Re Ferre
Published in: BMJ case reports (2020)
An 8-year-old girl of African descent presented to the hospital with a headache, lethargy, pallor and 'Coca-Cola'-coloured urine. She had been admitted 11 days before with Plasmodium falciparum malaria, which was successfully treated with 48 hours of parenteral artesunate. Investigations revealed signs of severe haemolytic anaemia, with a haemoglobin level of 52 g/L that reached a nadir of 10 g/L within 4 hours, in addition to haemoglobinuria, hyperbilirubinaemia and raised lactate dehydrogenase levels. She was diagnosed with post-artemisinin delayed haemolysis, which is usually self-limiting but has the potential to cause severe, life-threatening anaemia 7-21 days following malaria treatment with artesunate. There was excellent response to blood transfusion, and the child made a full recovery. This case highlights the importance of providing safety netting advice regarding signs and symptoms of anaemia to patients receiving artesunate, in addition to monitoring of haemoglobin levels in the weeks after treatment.
Keyphrases
  • plasmodium falciparum
  • iron deficiency
  • mental health
  • early onset
  • healthcare
  • single cell
  • emergency department
  • drug induced
  • intellectual disability
  • physical activity
  • autism spectrum disorder
  • depressive symptoms