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HMS-Related Hemolysis after Acute Attacks of Plasmodium vivax Malaria
Among a cohort of 1,213 cases treated for Plasmodium vivax malaria from an isolated Papua New Guinean population, seven adults with severe and sustained hemolytic anemia after clearance of the peripheral parasitemia were prospectively investigated. All the patients fulfilled the criteria for hyper-reactive malarial splenomegaly and in 2 of 7 cases an IgG warm antibody was identified. Hereditary hemolytic anemia was excluded in 5 of 5 patients. All treated cases improved after an initial high dose of prednisone and antimalarial chemoprophylaxis. The persistence of marked anemia in a patient with splenomegaly after a P. vivax attack should raise the suspicion of hyper-reactive malarial splenomegaly.
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Author Notes
Financial support: This work was supported by InternationalSOS (Australasia) Pty Ltd and Newcrest Mining Ltd. The sponsor had no role in the study design, data collection and analysis, data interpretation, or writing of the manuscript.
Authors' addresses: Oriol Mitjà, Russell Hays, James Malken, and Anthony Ipai, Department of Medicine, Lihir Medical Centre, Lihir Island, NIP, Papua New Guinea, E-mails: oriolmitja@hotmail.com, rhays@ozemail.com.au, James.Malken@newcrest.au.com, and Anthony.Ipai@newcrest.au.com. Samson Kangapu, Department of Microbiology, Lihir Medical Centre, Lihir Island, NIP, Papua New Guinea, E-mail: Samson.Kangapu@newcrest.com.au. Jenny Robson, Department of Microbiology, Sullivan Nicolaides Pathology, Brisbane, Australia, E-mail: jrobson@snp.com.au. Quique Bassat, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/University of Barcelona, Barcelona, Spain, E-mail: quique.bassat@cresib.cat.