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Post-Artesunate Delayed Haemolysis — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsPost-Artesunate Delayed HaemolysisSCE Infectious Diseases

A 35-year-old woman develops severe malaria with P. falciparum parasitaemia of 15%. She is treated with IV Artesunate. On day 10 post-treatment, despite parasitological cure, she develops new-onset anaemia (Hb drops from 110 to 68 g/L) with raised LDH, low haptoglobin, and positive direct Coombs test. What is the most likely diagnosis?

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Correct answer: C — Post-artesunate delayed haemolysis (PADH)

Post-artesunate delayed haemolysis (PADH) is a recognised complication occurring 7–21 days after IV Artesunate treatment, particularly in patients with high initial parasitaemia (>5%). It is caused by delayed clearance of previously parasitised ('once-infected') erythrocytes that were pitted and returned to the circulation. The haemolysis can be severe enough to require transfusion. UKHSA and WHO recommend haemoglobin monitoring at day 14 after IV Artesunate treatment. It occurs in approximately 10–15% of patients.

Reference: UKHSA/UKMEAG 2016 – UK malaria treatment guidelines (recommendation 15); WHO 2022 – Malaria