Case Series of Primaquine-Induced Haemolytic Events in Controlled Trials with G6PD Screening
Issued Date
2023-09-01
Resource Type
eISSN
20760817
Scopus ID
2-s2.0-85172871987
Journal Title
Pathogens
Volume
12
Issue
9
Rights Holder(s)
SCOPUS
Bibliographic Citation
Pathogens Vol.12 No.9 (2023)
Suggested Citation
Kosasih A., James R., Chau N.H., Karman M.M., Panggalo L.V., Wini L., Thanh N.V., Obadia T., Satyagraha A.W., Asih P.B.S., Syafruddin D., Taylor W.R.J., Mueller I., Sutanto I., Karunajeewa H., Pasaribu A.P., Baird J.K. Case Series of Primaquine-Induced Haemolytic Events in Controlled Trials with G6PD Screening. Pathogens Vol.12 No.9 (2023). doi:10.3390/pathogens12091176 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90357
Title
Case Series of Primaquine-Induced Haemolytic Events in Controlled Trials with G6PD Screening
Author's Affiliation
Badan Riset dan Inovasi Nasional
Mahidol Oxford Tropical Medicine Research Unit
Oxford University Clinical Research Unit
Université Paris Cité
Universitas Sumatera Utara
Hasanuddin University
Universitas Indonesia
Walter and Eliza Hall Institute of Medical Research
University of Melbourne
Nuffield Department of Medicine
Exeins Health Initiative
Solomon Islands Ministry of Health and Medical Services
Mahidol Oxford Tropical Medicine Research Unit
Oxford University Clinical Research Unit
Université Paris Cité
Universitas Sumatera Utara
Hasanuddin University
Universitas Indonesia
Walter and Eliza Hall Institute of Medical Research
University of Melbourne
Nuffield Department of Medicine
Exeins Health Initiative
Solomon Islands Ministry of Health and Medical Services
Other Contributor(s)
Abstract
Primaquine for radical cure of Plasmodium vivax malaria poses a potentially life-threatening risk of haemolysis in G6PD-deficient patients. Herein, we review five events of acute haemolytic anaemia following the administration of primaquine in four malaria trials from Indonesia, the Solomon Islands, and Vietnam. Five males aged 9 to 48 years were improperly classified as G6PD-normal by various screening procedures and included as subjects in trials of anti-relapse therapy with daily primaquine. Routine safety monitoring by physical examination, urine inspection, and blood haemoglobin (Hb) assessment were performed in all those trials. Early signs of acute haemolysis, i.e., dark urine and haemoglobin drop >20%, occurred only after day 3 and as late as day 8 of primaquine dosing. All patients were hospitalized and fully recovered, all but one following blood transfusion rescue. Hb nadir was 4.7 to 7.9 g/dL. Hospitalization was for 1 to 7 days. Hb levels returned to baseline values 3 to 10 days after transfusion. Failed G6PD screening procedures in these trials led G6PD-deficient patients to suffer harmful exposures to primaquine. The safe application of primaquine anti-relapse therapy requires G6PD screening and anticipation of its failure with a means of prompt detection and rescue from the typically abrupt haemolytic crisis.