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Fatal case of delayed-onset haemolytic anaemia after oral artemether–lumefantrine
  1. Lotta Gustafsson,
  2. Sunil James,
  3. Yimeng Zhang and
  4. Karunakaran Pradeep Thozhuthumparambil
  1. Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  1. Correspondence to Dr Sunil James; sunil.james1{at}


Artemisinin derivatives are used globally in the management of falciparum malaria. Postartemisinin delayed haemolysis (PADH) is a recognised adverse event contributing to severe anaemia. To the best of our knowledge, we report the first recorded fatal case of PADH. A 60-year-old woman presented with two episodes of collapse at home and feeling generally unwell. She had recently been treated for uncomplicated falciparum malaria 1 month prior with artemether 80 mg/lumefantrine 480 mg in Congo. Her results on admission revealed an anaemia (haemoglobin 43 g/L), raised lactate dehydrogenase and positive direct antiglobulin test that suggested an intravascular haemolytic process. She made a capacitous decision to refuse blood products in line with her personal beliefs. Despite best supportive treatment, she did not survive. This case highlights the importance of postartemisinin follow-up and should encourage discussion and careful consideration of its use in the context of lack of access to/patient refusal of blood products.

  • haematology (incl blood transfusion)
  • drugs: infectious diseases
  • travel medicine
  • tropical medicine (infectious disease)
  • unwanted effects / adverse reactions

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  • Contributors LG and SJ drafted the initial paper. YZ edited the paper and created the figures. KPT finalised the paper. All authors agreed on the final draft.

  • 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.

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