Blackwater fever

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Blackwater fever is also called as malarial hemoglobinuria. It is a rare complication of malaria which occurs in cases of P. falciparum infection.

It occurs following quinine treatment to subjects previously infected with P. falciparum.

Blackwater fever is characterized by massive hemolysis after treatment for acute malaria.

What happens in blackwater fever is that the red blood cells burst in the bloodstream (hemolysis). Because of the hemolysis, hemoglobin is released directly into the blood vessels. This free hemoglobin damages the glomerulus in the kidney and begins to leak into the urine where it causes further damage to the tubules of the kidney. As a result, kidney failure frequently occurs.

The development of blackwater fever has an autoimmune mechanism. After treatment of acute malaria with quinine, antibodies are formed against parasitized and quininized RBCs. With subsequent P. falciparum infection and quinine treatment, there is immunocomplex formation. This is followed by complement mediated massive destruction of both parasitized and nonparasitized RBCs. 

A decrease in cases of blackwater fever was seen when artemisinin compounds replaced quinine as first-line treatment for malaria.

Symptoms of blackwater fever

High fever, chills

Anemia 

Black or dark red urine

Jaundice

Treatment

Antimalarial drugs

Intravenous fluid

Whole blood transfusions

Supportive care such as Intensive care and Dialysis may be required

Discussion

Why is Blackwater fever named so?

The name of the syndrome relates to the presence of dark urine seen in affected patients

Why is the colour of urine black or dark red in blackwater fever?

Due to the presence of large amounts of hemoglobin that is released because of extensive destruction of the red blood cells by malarial parasites

Why does anemia occur in Blackwater fever?

Number of red blood cells fall very low and lead to anemia because of extensive destruction of the red blood cells by malarial parasites

What kind of hemolysis is seen in Blackwater fever?

Intravascular hemolysis