MARVIN M. ADNER, M.D.; LESLIE B. ALTSTATT, M.D.; MARCEL E. CONRAD, M.D., F.A.C.P.
In a study of 131 soldiers evacuated from Vietnam with drug-resistant Plasmodium falciparum malaria, 4 patients were found with a positive direct antiglobulin test of the immunoglobulin (Ig) G type. In three patients the positive Coombs' tests seemed temporally related to the administration of quinine for relapsed malaria and were associated with hemolysis. Two of these patients had a quinine-related dermatitis, one developed blackwater fever within hours after the initiation of quinine therapy, and another had a panagglutinin in quinine-free red cell eluates. The fourth patient had compensated hemolysis and a positive direct Coombs' test which seemed unrelated to quinine therapy. The indirect Coombs' test was negative in all subjects, and no antiquinine antibodies were found in sera or red cell eluates from these patients.
Coombs'-positive hemolytic disease is an unusual complication of malarial infections. Clinical observations in man suggest that quinine has a causal role in the hemolytic reaction. The mechanism by which this drug-induced hemolysis occurs is not known.
ADNER MM, ALTSTATT LB, CONRAD ME. Coombs'-Positive Hemolytic Disease in Malaria. Ann Intern Med. ;68:33–38. doi: 10.7326/0003-4819-68-1-33
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Published: Ann Intern Med. 1968;68(1):33-38.
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