Association of G6PD status and haemolytic anaemia in patients receiving anti-malarial agents: a systematic review and meta-analysis

Malar J. 2023 Mar 5;22(1):77. doi: 10.1186/s12936-023-04493-7.


Background: Some anti-malarial drugs often cause haemolytic anaemia in glucose-6-phosphate-dehydrogenase deficiency (G6PDd) patients. This study aims to analyse the association of G6PDd and anaemia in malaria patients receiving anti-malarial drugs.

Methods: A literature search was performed in major database portals. All studies searched using keywords with Medical Subject Headings (MeSH) were included, without date or language restriction. Pooled mean difference of haemoglobin and risk ratio of anaemia were analysed using RevMan.

Results: Sixteen studies comprising 3474 malaria patients that included 398 (11.5%) with G6PDd were found. Mean difference of haemoglobin in G6PDd/G6PD normal (G6PDn) patients was - 0.16 g/dL (95% CI - 0.48, 0.15; I2 5%, p = 0.39), regardless of the type of malaria and dose of drugs. In particular with primaquine (PQ), mean difference of haemoglobin in G6PDd/G6PDn patients with dose < 0.5 mg/kg/day was - 0.04 (95% CI - 0.35, 0.27; I2 0%, p = 0.69). The risk ratio of developing anaemia in G6PDd patients was 1.02 (95% CI 0.75, 1.38; I2 0%, p = 0.79).

Conclusion: Single or daily standard doses of PQ (0.25 mg/kg/day) and weekly PQ (0.75 mg/kg/week) did not increase the risk of anaemia in G6PDd patients.

Keywords: Antimalarial; G6PD deficiency; Malaria falciparum; Malaria vivax; Primaquine.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Antimalarials*
  • Glucosephosphate Dehydrogenase
  • Glucosephosphate Dehydrogenase Deficiency*
  • Hemoglobins
  • Humans
  • Primaquine


  • Antimalarials
  • Glucosephosphate Dehydrogenase
  • Primaquine
  • Hemoglobins