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Delayed haemolysis following artesunate in a child with profound anaemia and Coca-Cola-coloured urine
  1. Neaha Patel,
  2. Julia Thomson and
  3. Lucia Re Ferre
  1. Paediatrics Department, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Neaha Patel; neaha.patel{at}


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.

  • paediatrics
  • haematology (including blood transfusion)
  • global health
  • infectious diseases
  • tropical medicine (infectious disease)

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  • Contributors NP: idea for the case report and writing of the report. JT: editing of the report. LRF: patient consent and follow-up. Patient was under the care of both JT and LRF. Final report approved by NP, JT and LRF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.