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Autoimmune hemolytic anemia and autoantibodies in a patient with Plasmodium falciparum infection: report of a rare case and review of the literature


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Figure 1

(A and B) Both thick and thin blood films showing a ring form of Plasmodium falciparum parasite with normal finding of red blood cells (RBCs) on the first day of admission. (C) Peripheral blood film from the fourth day after antimalaria treatment. The RBCs, leukocytes, and platelets are normal. (D) Peripheral blood film showing RBCs with autoagglutination and microspherocytosis. (E) On the fifth day after steroid treatment, some clumping of RBCs is seen on peripheral blood film. (F) Peripheral blood film showing RBCs, leukocytes, and platelets are normal at the second week after steroid treatment. All scale bars indicate 10 μm.
(A and B) Both thick and thin blood films showing a ring form of Plasmodium falciparum parasite with normal finding of red blood cells (RBCs) on the first day of admission. (C) Peripheral blood film from the fourth day after antimalaria treatment. The RBCs, leukocytes, and platelets are normal. (D) Peripheral blood film showing RBCs with autoagglutination and microspherocytosis. (E) On the fifth day after steroid treatment, some clumping of RBCs is seen on peripheral blood film. (F) Peripheral blood film showing RBCs, leukocytes, and platelets are normal at the second week after steroid treatment. All scale bars indicate 10 μm.

Figure 2

Evolution of autoimmune hemolytic anemia and development of autoantibodies during severe Plasmodium falciparum malaria infection treated with intravenous artesunate.
Evolution of autoimmune hemolytic anemia and development of autoantibodies during severe Plasmodium falciparum malaria infection treated with intravenous artesunate.

Summary of patients with malaria concomitant with autoimmune hemolytic anemia

Reference/Present[2][3][4][7]
Characteristiccase (2016)
Age (years)422717157157
SexFemaleMaleFemaleFemaleFemaleFemaleMale
Presenting symptomFeverFeverFeverFeverFeverFeverFever
(7 days)(2 days)(7 days)(4 days)(7 days)(14 days)(3 days)
Malaria infectionP.fP.fP.fP.v. + P.fP.v. + P.fP.fP.v
Anti-malarialArtesunateAntimalarialArtemether/lumefantrineArtesunate i.vArtesunateArtesunate i.vChloroquine
regimen (duration)i.v. (7 days)treatment(6 days) and then artesunate(5 days)i.v. (5 days) +(N/A)(2 days) + primaquine
(unknown)(2 days)mefloquine(14 days)
Other antibioticCeftriaxoneN/ACeftriaxone, metronidazoleCeftriaxoneCeftriaxoneCeftriaxoneNEG
treatmentgentamicin, piperacillindoxycycline
ciprofloxacin
Onset of AIHA (days12th1st14th9th7th11th2nd
after antimalarial
treatment)
Diagnostic method
Hemoglobin3.5Hct. 15.2%4.64.85.14.55.2
(g/dL)
Coombs testPOSNEGPOSNEGN/ANEGPOS
LDH (U/L)HighN/AHighHighHighHighN/A
Identify cause
ANANEGN/ANEGNEGPOSNEGN/A
CA test POSCA test POS
AntibodyAutoanti-EN/AN/AN/AN/AN/AAutoanti-I
identificationAutoanti-I
Specific treatmentPredniNoMethylprednisolonePrednisolonePrednisolonePrednisolonePrednisolone
for AIHA (dosage)solone(60 mg/day × 7 days)(1 MKD)(N/A)(0.5 MKD)(1 MKD)
(1 MKD)Prednisolone (1 MKD)
PRC transfusion1002301
(unit)
Duration of recovery
Malaria infection5N/AN/AN/A7112
(days)
AIHA, anemia (days)84728285610
Stop prednisolone30N/A604228N/A56
(days)
eISSN:
1875-855X
Idioma:
Inglés
Calendario de la edición:
6 veces al año
Temas de la revista:
Medicine, Assistive Professions, Nursing, Basic Medical Science, other, Clinical Medicine