Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins

作者：Jaureguiberry Stephane; Ndour Papa A; Roussel Camille; Ader Flavie; Safeukui Innocent; Nguyen Marie; Biligui Sylvestre; Ciceron Liliane; Mouri Oussama; Kendjo Eric; Bricaire Francois; Vray Muriel; Angoulvant Adela; Mayaux Julien; Haldar Kasturi; Mazier Dominique; Danis Martin; Caumes Eric; Thellier Marc; Buffet Pierre^*

来源：Blood, 2014, 124(2): 167-175.

DOI：10.1182/blood-2014-02-555953

Patients with severemalaria treated with artesunate sometimes experience a delayed hemolytic episode. Artesunate (AS) induces pitting, a splenic process whereby dead parasites are expelled from their host erythrocytes. These once-infected erythrocytes then return to the circulation. We analyzed hematologic parameters in 123 travelers treated with AS for severe malaria. Among 60 nontransfused patients observed for more than 8 days, 13 (22%) had delayed hemolysis. The peak concentration of circulating once-infected erythrocytes was measured during the first week in 21 patients and was significantly higher in 9 patients with delayed hemolysis than in 12 with other patterns of anemia (0.30 vs 0.07; P = .0001). The threshold of 180 million once-infected erythrocytes per liter discriminated patients with delayed hemolysis with 89% sensitivity and 83% specificity. Once-infected erythrocyte morphology analyzed by using ImageStream in 4 patients showed an 8.9% reduction in their projected area, an alteration likely contributing to their shorter lifespan. Delayed clearance of infected erythrocytes spared by pitting during AS treatment is an original mechanism of hemolytic anemia. Our findings consolidate a disease framework for posttreatment anemia in malaria in which delayed hemolysis is a new entity. The early concentration of once-infected erythrocytes is a solid candidate marker to predict post-AS delayed hemolysis

• 出版日期2014-7-10