PADH can be a clinically relevant side effect after parenteral artesunate treatment.
Because all previously reported cases were treated with parenteral artesunate produced by facilities not accredited for good manufacturing practice (GMP) standards, direct toxicity resulting from treatment with non-GMP parenteral artesunate had been hypothesized as a PADH cause (6).
The development of such a point-of-care test that can identify patients at risk for PADH with a high sensitivity and specificity would be useful in identifying those patients who would benefit from more stringent follow-up (8).
PADH likely is the result of the delayed clearance of once-infected erythrocytes, which continue to circulate after the pharmacologic effect of parenteral artesunate, and is not the result of any toxic effect of parenteral artesunate.
In addition to 18 new PADH cases identified through a literature review, one U.
The nonPADH and PADH patterns were observed in 51 (65.
4), respectively, for patients with non-PADH and PADH anemia (p = 0.
The death rate was 5%, and blood transfusion was necessary for <20% of all patients and for <5% of patients with PADH anemia.
PADH occurred in 27% of patients in this study, but it was rarely associated with severe anemia and was never fatal.
We have shown that the risk for PADH is linked to the peak number of pitted erythrocytes rather than the absolute initial level of parasitemia (31).
In addition, patients with PADH whose anemia was well tolerated may have gone unreported or been lost to followup.