Table 3.
Characteristics and clinical outcomes of individuals with severe primaquine-associated hemolysis
| Clinical manifestations of severe hemolysis | Probable PQ associated (n = 48) | Possible PQ associated (n = 53) | Uncertain PQ associated (n = 62) | |||
|---|---|---|---|---|---|---|
| N | n (%) | N | n (%) | N | n (%) | |
| Symptoms and signs | ||||||
| Dark urine | 36 | 29 (80.6) | 38 | 34 (89.5) | 39 | 38 (97.4) |
| Pallor | 40 | 38 (95.0) | 35 | 31 (88.6) | 40 | 36 (90.0) |
| Dyspnea | 33 | 9 (27.3) | 26 | 7 (26.9) | 30 | 2 (6.7) |
| Dizziness | 17 | 9 (52.9) | 9 | 4 (44.4) | 8 | 3 (37.5) |
| Fever | 38 | 24 (63.2) | 31 | 16 (51.6) | 32 | 7 (21.9) |
| Severe fatigue | 20 | 13 (65.0) | 6 | 5 (83.3) | 3 | 2 (66.7) |
| Heart failure | 31 | 3 (9.7) | 31 | 6 (19.4) | 33 | 0 (0.0) |
| Chest pain | 7 | 1 (14.3) | 3 | 0 (0.0) | 0 | 0 (0.0) |
| Jaundice | 44 | 39 (88.6) | 48 | 44 (91.7) | 54 | 47 (87) |
| Low urine output | 14 | 2 (14.3) | 4 | 0 (0.0) | 5 | 2 (40) |
| Laboratory findings | ||||||
| Glucose 6-phosphate dehydrogenase | ||||||
| Normal | 47 | 0 (0.0) | 51 | 1 (2.0) | 61 | 5 (8.2) |
| Intermediate | 47 | 2 (4.4) | 51 | 0 (0.0) | 61 | 0 (0.0) |
| Deficient | 47 | 45 (95.7) | 51 | 50 (98.0) | 61 | 56 (91.8) |
| Total bilirubin, > 1 mg/dL | 37 | 31 (83.8) | 38 | 35 (92.1) | 52 | 46 (88.5) |
| Indirect bilirubin, > 0.8 mg/dL | 36 | 30 (83.3) | 36 | 33 (91.7) | 43 | 37 (86.1) |
| Urine dipstick blood, positive | 21 | 10 (47.6) | 27 | 19 (60.4) | 31 | 21 (67.7) |
| Urine dipstick urobilinogen, positive | 20 | 3 (15) | 25 | 14 (66) | 30 | 12 (40) |
| White blood cell count, > 12,000/μL | 32 | 20 (62.5) | 38 | 20 (52.6) | 36 | 10 (27.8) |
| Target daily dose of PQ | ||||||
| 0.25 mg/kg/day | 47 | 5 (10.6) | 52 | 12 (23.1) | 57 | 14 (24.6) |
| 0.5 mg/kg/day | 47 | 36 (76.6) | 52 | 39 (75.0) | 57 | 43 (75.4) |
| 0.75 mg/kg/day | 47 | 2 (4.3) | 52 | 0 (0.0) | 57 | 0 (0.0) |
| 1.0 mg/kg/day | 47 | 4 (8.5) | 52 | 1 (1.9) | 57 | 0 (0.0) |
| Management | ||||||
| Blood transfusion | 48 | 45 (93.8) | 42 | 31 (73.8) | 43 | 0 (0.0) |
| Renal replacement therapy | 39 | 4 (10.3) | 41 | 4 (9.8) | 42 | 0 (0.0) |
| Hospitalized (no blood transfusion or renal replacement therapy) | 48 | 3 (6.3) | 41 | 8 (19.5) | 42 | 42 (100) |
| Outcome | ||||||
| Died | 48 | 0 (0.0) | 53 | 7 (13.2) | 62 | 0 (0.0) |
N = number of patients for whom data were available; n = number of patients with manifestation present.