From the Guidelines
Malaria, particularly Plasmodium falciparum, is a significant infection that can cause hemolysis. According to the study by S. Antinori et al. 1, malaria is a well-known cause of hemolysis, and the use of certain antimalarial drugs like primaquine and tafenoquine can also lead to hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Mechanisms of Hemolysis
Hemolysis in malaria occurs through various mechanisms, including:
- Direct invasion of red blood cells by the parasite
- Production of toxins that damage cell membranes
- Immune-mediated destruction where antibodies target infected cells
- Activation of complement pathways
Clinical Manifestations
The severity of hemolysis varies by pathogen and can manifest as:
- Anemia
- Jaundice
- Dark urine
- Fatigue
Treatment
Treatment focuses on addressing the underlying infection with appropriate antimicrobials, such as artemisinin-based combination therapies (ACTs) for malaria, while providing supportive care for anemia. In severe cases, transfusions may be necessary to maintain adequate oxygen delivery to tissues until the infection is controlled and normal red blood cell production resumes.
Important Considerations
It is essential to note that certain antimalarial drugs, like primaquine and tafenoquine, can cause hemolytic anemia in patients with G6PD deficiency, and therefore, testing for G6PD deficiency is crucial before administering these drugs 1. Additionally, post-artemisinin delayed haemolysis (PADH) is a potential complication of ACTs, and its incidence can be significant, as reported in a study by Kurth et al. [@60@].
From the Research
Infections Causing Hemolysis
- Clostridium perfringens infection can cause hemolysis, as it produces toxins that can disrupt red blood cells, leading to intravascular hemolysis and septic shock 2, 3, 4
- The infection can be severe and potentially lethal, especially in individuals with underlying risk factors such as immunosuppression, malignancy, and diabetes 2, 3
- Other infections may also cause hemolysis, including those caused by Plasmodium falciparum, which can lead to malaria 5
- The relationship between hemolysis and infection can be complex, with different cause-and-effect relationships categorized, including infections causing hemolysis by invasion of red blood cells, by hemolysins, or by immune mechanisms 6
Characteristics of Hemolysis Caused by Infections
- Hemolysis caused by Clostridium perfringens infection can be characterized by massive intravascular hemolysis, which can lead to rapid deterioration and death if left untreated 2, 3, 4
- The use of antibiotics, such as beta-lactam antibiotics and clindamycin, can be effective in treating the infection, and surgical intervention may also be necessary in some cases 2, 3
- Early recognition and treatment of the infection are critical for patient survival, as the disease can progress rapidly to death 3