Coombs'-Positive Hemolytic Disease in Malaria

Abstract

In 131 soldiers evacuated from Vietnam with drug resistant Plasmodium falciparum malaria. 4 patients were found with a positive direct anti-globulin test of the Ig G type. In 3 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, 1 developed blackwater fever within hr. after the initiation of quinine therapy and another had a panag-glutinin in quinine-free red cell eluates. The 4th 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. Coombs-positive hemolytic disease is an unusual complication of malarious 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.