Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
BMJ Case Rep. 2021 Nov 19;14(11):e245718. doi: 10.1136/bcr-2021-245718.
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.
青蒿素衍生物在全球范围内用于治疗恶性疟原虫疟疾。青蒿素类药物后迟发性溶血（PADH）是一种公认的不良事件，可导致严重贫血。据我们所知，我们报告了首例记录在案的 PADH 致死病例。一名 60 岁女性因在家中两次晕倒和全身不适而就诊。她在 1 个月前曾在刚果接受过简单的恶性疟原虫疟疾治疗，使用了青蒿琥酯 80mg/盐酸阿莫地喹 480mg。她入院时的检查结果显示贫血（血红蛋白 43g/L）、乳酸脱氢酶升高和直接抗球蛋白试验阳性，提示存在血管内溶血过程。她根据个人信仰做出了拒绝输血的决定。尽管进行了最佳支持治疗，但她还是未能幸存。该病例强调了青蒿素类药物后随访的重要性，并应鼓励在缺乏血液制品供应或患者拒绝使用血液制品的情况下，对其使用进行讨论和仔细考虑。
