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. 2021 Apr 29;20(1):206.
doi: 10.1186/s12936-021-03735-w.

Systematic analysis of direct antiglobulin test results in post-artesunate delayed haemolysis

Tommaso Ascoli Bartoli  1 , Luciana Lepore  1 , Alessandra D'Abramo  2 , Giovanna Adamo  1 , Angela Corpolongo  1 , Laura Scorzolini  1 , Maria Letizia Giancola  1 , Nazario Bevilacqua  1 , Claudia Palazzolo  1 , Andrea Mariano  1 , Giuseppe Ippolito  1 , Pierre Buffet  3   4 , Emanuele Nicastri  1
Affiliations

Systematic analysis of direct antiglobulin test results in post-artesunate delayed haemolysis

Tommaso Ascoli Bartoli et al. Malar J. .

Abstract

Background: Post-artesunate delayed haemolysis (PADH) is common after severe malaria episodes. PADH is related to the "pitting" phenomenon and the synchronous delayed clearance of once-infected erythrocytes, initially spared during treatment. However, direct antiglobulin test (DAT) positivity has been reported in several PADH cases, suggesting a contribution of immune-mediated erythrocyte clearance. The aim of the present study was to compare clinical features of cases presenting a positive or negative DAT.

Methods: Articles reporting clinical data of patients diagnosed with PADH, for whom DAT had been performed, were collected from PubMed database. Data retrieved from single patients were extracted and univariate analysis was performed in order to identify features potentially related to DAT results and steroids use.

Results: Twenty-two studies reporting 39 PADH cases were included: median baseline parasitaemia was 20.8% (IQR: 11.2-30) and DAT was positive in 17 cases (45.5%). Compared to DAT-negative individuals, DAT-positive patients were older (49.5 vs 31; p = 0.01), had a higher baseline parasitaemia (27% vs 17%; p = 0.03) and were more commonly treated with systemic steroids (11 vs 3 patients, p = 0.002). Depth and kinetics of delayed anaemia were not associated with DAT positivity.

Conclusions: In this case series, almost half of the patients affected by PADH had a positive DAT. An obvious difference between the clinical courses of patients presenting with a positive or negative DAT was lacking. This observation suggests that DAT result may not be indicative of a pathogenic role of anti-erythrocytes antibodies in patients affected by PADH, but it may be rather a marker of immune activation.

Keywords: Artemisinins; Artesunate; Coombs test; Drug-related side effects and adverse reactions; Hemolytic anemia; Malaria.

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Conflict of interest statement

The research team of Pierre Buffet received support from Guilin Laboratories in 2017–2020 for the surveillance of artesunate efficacy and toxicity in France. The author provided expertise for FastTrack Drugs & Biologics LLC and Sigma-Tau Pharmaceuticals from 2013 to 2016, and provided expertise to Sanofi Aventis Research & Development from 2013 to 2015.

All other authors report no potential conflicts.

Figures

Fig. 1
Fig. 1
Systematic analysis flowchart. Reports of patients affected by PADH with an available DAT result
See this image and copyright information in PMC

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