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.