Volume 22, Number 8—August 2016
Research
Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria
Florian Kurth
, Tilman Lingscheid, Florian Steiner, Miriam S. Stegemann, Sabine Bélard, Nikolai Menner, Peter Pongratz, Johanna Kim, Horst von Bernuth, Beate Mayer, Georg Damm, Daniel Seehofer, Abdulgabar Salama, Norbert Suttorp, and Thomas Zoller
, Tilman Lingscheid, Florian Steiner, Miriam S. Stegemann, Sabine Bélard, Nikolai Menner, Peter Pongratz, Johanna Kim, Horst von Bernuth, Beate Mayer, Georg Damm, Daniel Seehofer, Abdulgabar Salama, Norbert Suttorp, and Thomas Zoller
Table
Baseline characteristics and follow-up laboratory data for patients with uncomplicated Plasmodium falciparum malaria who were given ACT*
| Characteristic | All, n = 20 | Without posttreatment hemolysis, n = 12 | With posttreatment hemolysis, n = 8 | p value | With compensated posttreatment hemolysis, n = 4 | With uncompensated posttreatment hemolysis, n = 4 | p value |
|---|---|---|---|---|---|---|---|
| Baseline | |||||||
| Age, y | 35 (26–40) | 31 (17–40) | 38 (30–43) | 0.18 | 32 (22–42) | 40 (27–46) | 0.15 |
| Children | 3/20 (15.0) | 3/12 (25.0) | 0/8 (0) | 0.24 | 0/4 (0) | 0 (0) | |
| African ethnicity | 13/20 (65.0) | 9/12 (75.0) | 4/8 (50.0) | 0.35 | 4/4 (100.0) | 0/4 (0) | 0.001 |
| Female sex | 9/20 (45.0) | 7/12 (58.3) | 2/8 (25.0) | 0.19 | 2/4 (50.0) | 0/4 (0) | 0.42 |
| Treatment with ARM/LUM | 5/20 (25.0) | 4/12 (33.3) | 1/8 (12.5) | 0.60 | 0/4 (0) | 1/4 (25.0) | 1.0 |
| Treatment with DHA/PPQ | 15/20 (75.0) | 8/12 (75.0) | 7/8 (87.5) | 0.60 | 4/4 (100.0) | 3/4 (75.0) | 1.0 |
| Parasitemia† | 0.4 (0.2–1.1) | 0.3 (0.1–0.9) | 0.9 (0.4–1.4) | 0.12 | 1.15 (0.4–1.9) | 0.8 (0.2–1.1) | 0.40 |
| Hb d0‡ |
12.5
(11.1–14.0) |
11.3
(10.5–13.5) |
13.1
(12.5–14.1) |
0.11 |
12.7
(12.4–13.8) |
13.7
(12.6–14.6) |
0.30 |
| Laboratory follow-up‡ | |||||||
| Hb d3 | 12.2 (10.6–13.6) | 11.1 (9.7–12.7) | 13.2 (12.2–14.3) | 0.02 | 12.8 (11.9–13.4) | 14.2 (12.5–14.6) | 0.15 |
| Hb d7 | 12.1 (11.1–13.0) | 11.7 (10.5–12.5) | 12.5 (11.9–12.6) | 0.33 | 12.6 (11.8–13.1) | 12.7 (11.5–12.9) | 0.66 |
| Hb d14 | 12.0 (10.9–12.6) | 11.7 (10.5–12.6) | 12.2 (11.9–12.6) | 0.33 | 12.5 (12.2–12.8) | 11.9 (10.5–12.5) | 0.11 |
| ΔHb d0–d3 | −0.4 (−0.8 to 0.0) | −0.5 (−1.0 to −0.3) | −0.1 (−0.6 to 0.6) | 0.07 | −0.4 (−1.1 to 0.7) | 0.1 (−0.2 to 0.6) | 0.40 |
| ΔHb d3–d7 | 0.0 (−0.8 to 0.5) | 0.3 (0.3–0.8) | −0.8 (−1.5 to −0.1) | 0.007 | −0.3 (−0.6 to 0.2) | −1.5 (−1.7 to −1.0) | NA |
| ΔHb d7–d14 | 0.1 (−0.5 to 0.5) | 0.3 (0.1–0.5) | −0.4 (−0.9 to 0.1) | 0.04 | 0.0 (−0.4 to 0.4) | −0.8 (−1.2 to −0.3) | NA |
| ΔHb d3–d14 | 0.0 (−0.7 to 0.5) | 0.3 (−0.1 to 0.7) | −1.3 (−2.0 to −0.3) | 0.002 | −0.3 (−0.6 to 0.3) | −1.9 (−2.6 to −1.9) | NA |
| ΔHb d0–d14 | −0.7 (−1.1 to 0.1) | −0.4 (−0.8 to 0.4) | −1.3 (−2.1 to −0.3) | 0.03 | −0.4 (−1.3 to 0.2) | −1.9 (−2.8 to −1.3) | NA |
| LDH d7, U/L | 250 (225–331) | 244 (222–274) | 327 (229–407) | 0.16 | 329 (211–495) | 327 (248–381) | 0.77 |
| LDH d14, U/L | 256 (210–283) | 210 (197–247) | 280 (256–365) | 0.006 | 273 (255–394) | 298 (234–365) | 1.0 |
| RPI d3 | 0.5 (0.3–0.7) | 0.4 (0.2–0.7) | 0.7 (0.4–0.7) | 0.22 | 0.7 (0.4–0.7) | 0.6 (0.5–0.7) | 1.0 |
| RPI d7 | 1.4 (0.9–1.6) | 1.4 (0.9–1.5) | 1.3 (0.8–2.0) | 0.66 | 1.7 (1.2–2.7) | 1.0 (0.4–1.8) | 0.24 |
| RPI d14 | 1.4 (1.0–1.8) | 1.1 (1.0–1.6) | 1.9 (1.4–2.6) | 0.015 | 2.5 (1.9–2.9) | 1.5 (1.1–1.9) | 0.04 |
*Values are median (interquartile range) or n/N (%). ACT, artemisinin-based combination therapy; ARM, artemether; d, day; Δ, period between indicated days; DHA, dihydroartemisinin; Hb, hemoglobin; LDH, lactate dehydrogenase; LUM, lumefantrine; NA, not applicable; PPQ, piperaquine; RPI, reticulocyte production index.
†Percentage of erythrocytes infected.
‡Hb levels are in grams/deciliter.
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Page updated: July 15, 2016
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