09/12/2025
Supplementation Of Hematinics With Artesunate — Post Artesunate Delayed Hemolysis (Artesunate Induced Hemolysis)
An uncommon but serious adverse event occurring 1–3 weeks after treatment with artesunate for severe malaria. Characterized by a significant drop in hemoglobin levels and signs of hemolysis, even after the parasites are cleared.
The leading hypothesis is that after artesunate kills parasites, red blood cells that have had parasites removed from them are sent to the spleen (Pitting process). The pitting process causes these red blood cells to become smaller and less structurally sound, significantly shortening their lifespan. These compromised red blood cells are then more easily destroyed, leading to a delayed drop in hemoglobin levels.
While the benefits of artesunate outweigh the risks, hematological follow-up is crucial to detect and manage this complication.