XI · Day 4 · Apparent recovery Severe Falciparum Malaria12 / 18
Patient says: "I feel well. Can I go home?"
★ Distinction territoryDelayed post-artesunate haemolysis.
Volunteering this in a viva impresses examiners — most candidates omit it entirely.
Timing1–3 weeks after IV artesunate completion
MechanismSpleen pits ring stages → parasitised RBCs re-enter circulation → later haemolysed
IncidenceUp to 25% with hyperparasitaemia (>10% RBCs)
FeaturesFalling Hb · jaundice · dark urine · ↑ LDH · ↑ bilirubin · ↑ reticulocytes
MonitoringWeekly FBC · LDH · bilirubin · reticulocytes × 4 weeks
ManagementSupportive — transfuse if Hb <70 g/L or symptomatic
CICM Fellowship Masterclass · 2026Dr Timothy Chimunda FCICM