One haemolytic anaemia may hide another: Paroxysmal nocturnal haemoglobinuria masquerading as Plasmodium falciparum infection

<i>Plasmodium falciparum</i> infection can cause breakthrough haemolysis in patients with paroxysmal nocturnal haemoglobinuria.Low <i>P. falciparum</i> parasitemia in patients living in malaria-endemic regions is not always significant as these patients often carry acquired immunity.Patients from malaria-endemic regions presenting with severe sickness and low <i>P. falciparum</i> parasitemia must be assessed for other diseases, as it cannot explain heavy illness.Patients presenting with haemolytic anaemia, no schistocytes, a negative direct Coombs test and other unexplained cytopenia such as thrombocytopenia/neutropenia and other unexplained clinical manifestations such as dyspnoea, chest pain or erectile dysfunction should be assessed for paroxysmal nocturnal haemoglobinuria.