Introduction
Primaquine (PQ) is an 8-aminoquinoline drug which is used for malaria
treatment and prophylaxis(1). Primaquine is the key anti-malarial drug
that eliminates Plasmodium vivax hypnozoites and thus prevents
relapses(1,2). In order to prevent relapse, P. vivax or P.
ovale malaria in children and adults (except pregnant women, infants
aged < 6 months, women breastfeeding infants aged <
6 months, women breastfeeding older infants unless they are known no to
be G6PD deficient, and people with G6PD deficiency) are treated with a
14-day course (0.25-0.5 mg/kg body weight daily) of primaquine in all
transmission settings(3). Though it is widely recommended, it is
commonly not given to malaria patients because of its hemolytic toxicity
in glucose-6-phosphate dehydrogenase (G6PD) deficient patients(4,5).
Following primaquine drug therapy, the degree of hemolysis depends on
the dose administered and the severity of the enzyme deficiency(6). The
exact definitions for severe or clinically significant primaquine
associated hemolysis or hemolytic anemia are not established and the
diagnosis is based on decrease in hemoglobin level and/or clinical
manifestations(5). WHO recommends G6PD activity assessment before
administration of primaquine for radical cure(3). No diagnostic method
is applied in hospital settings in low resource settings to screen G6PD
enzyme activity prior to antimalarial treatment, and is usually detected
during the course of primaquine therapy (7), when patients present to
healthcare units with classical signs of hemolytic anemia(8). Approach
to safe primaquine therapy hooks upon the ability to test and confirm
G6PD normal status but the expensive technique which demands good
laboratory conditions and qualified technicians restrict the access to
these tests(7,9). We present a case of hemolytic anemia following PQ
treatment in an individual with quantitative G6PD analysis within normal
range.