Jingle bells, jingle bells
Jingle all the way
Oh what fun it is to tweet TeamHaem’s case today!
The haemolysis is self-limiting
No more parasites are seen
The pitted red cells that have lost malaria
Are being chomped up in the spleen
Jingle bells, jingle bells
Jingle all the way
Oh what fun it is to tweet TeamHaem’s case today!
The DAT is clearly negative
Steroids were not given today
Jingle can go back to work
All elves shout hooray!
Jingle bells, jingle bells
Jingle all the way
Oh what fun it is to tweet TeamHaem’s case today!
SUMMARY
With a parasite count of >5%, poor Jingle had severe malaria
As per NICE and WHO recommendations, IV artesunate was started. This cleared the parasites quickly.
Delayed haemolysis is a recognised complication of IV artesunate therapy. There is no clear evidence to guide management and all data comes from case reports/series. Some clinicians have given steroids, and a proportion do seem to be autoimmune, although it is likely to be self-limiting.
It appears that most of the haemolysis is due to the destruction of red cells that become pitted following death of the parasites.
Further reading:
Lalloo, D.G., Shingadia, D., Bell, D.J., Beeching, N.J., Whitty, C.J. and Chiodini, P.L., 2016. UK malaria treatment guidelines 2016. Journal of Infection, 72(6), pp.635-649.
