Table 1

Demographic and clinical characteristics of patients with 3 typical patterns of post-AS anemia

CharacteristicRising pattern n = 19Persistent pattern n = 10PADH pattern n = 13P
No.%No.%No.%
Male gender 12 63 8 80 7 54 .46 
Median (IQR) age, years 38 (21-49) 39 (25-47) 42 (34-53) .58 
Area of birth       .48 
 Africa 13 68 6 60 6 46  
 Europe and North America 5 26 4 40 7 54  
 South and Central America 1 5 0 0 0 0  
 Asia 0 0 0 0 0 0  
Median (IQR) time of illness before AS, days 4 (3-5) 4 (3-9) 4 (3-4) .65 
Selected severe malaria criteria at day 0        
 Neurologic impairment (any signs) 8 42 4 40 4 31 .84 
  At least lethargy, confusion, multiple convulsion, coma Glasgow Scale <11 4 21 0 0 0 0 .13 
 Respiratory distress (any signs) 0 0 0 0 1 8 .54 
  At least respiratory frequency >32/mn, crackles, pulmonary infiltrates (chest x-ray), PaO2 <60 mmHg, SpO2 <91%        
 Cardiocirculatory impairment (any signs) 3 16 1 10 4 31 .53 
  At least shock (systolic blood pressure ≤80 mmHg), peripheral signs of hypotension*        
  Vasopressive supportive drug 0 0 0 0 0 0  
 Spontaneous bleeding 0 0 0 0 0 0  
 Purpuric lesions 0 0 0 0 0 0  
 Macroscopic hemoglobinuria 3 16 1 10 0 0 .33 
 Jaundice and/or bilirubin >50 μmol/L 9 47 7 70 7 54 .57 
 Hypoglycemia (glucose <2.2 mmol/L) 0 0 0 0 1 8 .54 
 Acidosis (any signs) 1 5 0 0 0 0 1.00 
  At least plasma bicarbonate <15 mmol/L, acidemia pH <7.35        
 Hyperlactatemia (arterial lactate >1.8 mmol/L) 4 21 2 20 7 54 .12 
 Renal impairment        
  Creatinine >120 μmol/L 3 16 0 0 2 15 .57 
  Creatinine >265 μmol/L and/or blood urea nitrogen >17 mmol/L 2 11 0 0 0 0 .49 
 Anemia (Hb <7 g/dL or hematocrit <20%) 0 0 0 0 0 0  
  Median (IQR) hemoglobin at day 0 (g/dL) 11.4 (10-13) 11.8 (11-14) 13.6 (12-15) .019† 
  Median (IQR) nadir of hemoglobin before day 8 (g/dL) 9.0 (7-11) 9.9 (9-12) 11.2 (10-13) .004† 
  Median (IQR) loss of hemoglobin between day 0 and the day of the nadir before day 8 (g/dL) 2.3 (1-3) 1.9 (1-3) 2.3 (2-3) .91 
  Median RPI 1.1 (1-1.4)‡ 1.5 (1-2)|| 1.6 (1-3) .1 
 Hyperparasitemia (>4%) 7 37 5 50 12 92 .006# 
  Median (IQR) parasitemia at day 0 (% of infected red blood cells) 2.4 (0.4-7) 3.9 (0.4-12) 8.0 (6-14) .013† 
Total dose of AS (mg)      
 Median (IQR) total dose 755 (540-1020) 844 (577-970) 800 (603-925) .92 
Complementary qualitative features when available        
 DAT +/DAT realized 0 1 1** 2 1 3††  
 G6PD deficiency/G6PD realized 0 1 0 0 0 5  
 Abnormal Hb electrophoresis/Hb electrophoresis realized 1 2‡‡ 0 1 1 4a  
CharacteristicRising pattern n = 19Persistent pattern n = 10PADH pattern n = 13P
No.%No.%No.%
Male gender 12 63 8 80 7 54 .46 
Median (IQR) age, years 38 (21-49) 39 (25-47) 42 (34-53) .58 
Area of birth       .48 
 Africa 13 68 6 60 6 46  
 Europe and North America 5 26 4 40 7 54  
 South and Central America 1 5 0 0 0 0  
 Asia 0 0 0 0 0 0  
Median (IQR) time of illness before AS, days 4 (3-5) 4 (3-9) 4 (3-4) .65 
Selected severe malaria criteria at day 0        
 Neurologic impairment (any signs) 8 42 4 40 4 31 .84 
  At least lethargy, confusion, multiple convulsion, coma Glasgow Scale <11 4 21 0 0 0 0 .13 
 Respiratory distress (any signs) 0 0 0 0 1 8 .54 
  At least respiratory frequency >32/mn, crackles, pulmonary infiltrates (chest x-ray), PaO2 <60 mmHg, SpO2 <91%        
 Cardiocirculatory impairment (any signs) 3 16 1 10 4 31 .53 
  At least shock (systolic blood pressure ≤80 mmHg), peripheral signs of hypotension*        
  Vasopressive supportive drug 0 0 0 0 0 0  
 Spontaneous bleeding 0 0 0 0 0 0  
 Purpuric lesions 0 0 0 0 0 0  
 Macroscopic hemoglobinuria 3 16 1 10 0 0 .33 
 Jaundice and/or bilirubin >50 μmol/L 9 47 7 70 7 54 .57 
 Hypoglycemia (glucose <2.2 mmol/L) 0 0 0 0 1 8 .54 
 Acidosis (any signs) 1 5 0 0 0 0 1.00 
  At least plasma bicarbonate <15 mmol/L, acidemia pH <7.35        
 Hyperlactatemia (arterial lactate >1.8 mmol/L) 4 21 2 20 7 54 .12 
 Renal impairment        
  Creatinine >120 μmol/L 3 16 0 0 2 15 .57 
  Creatinine >265 μmol/L and/or blood urea nitrogen >17 mmol/L 2 11 0 0 0 0 .49 
 Anemia (Hb <7 g/dL or hematocrit <20%) 0 0 0 0 0 0  
  Median (IQR) hemoglobin at day 0 (g/dL) 11.4 (10-13) 11.8 (11-14) 13.6 (12-15) .019† 
  Median (IQR) nadir of hemoglobin before day 8 (g/dL) 9.0 (7-11) 9.9 (9-12) 11.2 (10-13) .004† 
  Median (IQR) loss of hemoglobin between day 0 and the day of the nadir before day 8 (g/dL) 2.3 (1-3) 1.9 (1-3) 2.3 (2-3) .91 
  Median RPI 1.1 (1-1.4)‡ 1.5 (1-2)|| 1.6 (1-3) .1 
 Hyperparasitemia (>4%) 7 37 5 50 12 92 .006# 
  Median (IQR) parasitemia at day 0 (% of infected red blood cells) 2.4 (0.4-7) 3.9 (0.4-12) 8.0 (6-14) .013† 
Total dose of AS (mg)      
 Median (IQR) total dose 755 (540-1020) 844 (577-970) 800 (603-925) .92 
Complementary qualitative features when available        
 DAT +/DAT realized 0 1 1** 2 1 3††  
 G6PD deficiency/G6PD realized 0 1 0 0 0 5  
 Abnormal Hb electrophoresis/Hb electrophoresis realized 1 2‡‡ 0 1 1 4a  

Numbers shown in bold reach significance.

DAT, direct antiglobulin test; G6PD, glucose-6-phosphate dehydrogenase; Hb, hemoglobin; Ht, hematocrit; mn, minutes; Pa02, arterial partial pressure of oxygen; RPI, reticulocyte production index, defined by [% Reticulocyte at peak × hematocrit value at nadir]/45] ×[1/Correction factor]40; SPo2, oxygen saturation.

*

peripheral signs of hypotension with systolic blood pressure >80 mmHg.

‡

n = 7.

||

n = 6.

n = 11.

†

Mann-Whitney U test, between patterns Rising and PADH.

#

Fisher exact test.

**

DAT + for IgG.

††

DAT + for IgM.

‡‡

Minor α thalassemia.

a

Sickle cell disease A/S hemoglobin.

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