Anemia is caused by accelerated destruction and removal of red cells by the spleen and by suppression of the bone marrow with ineffective erythropoiesis (1). Anemia can develop rapidly, and transfusion is often required (1). In some patients with P. falciparum, massive hemolysis causes hemoglobinemia, black urine, and renal failure (blackwater fever) (1). 1) White NJ, Breman JG. Malaria and Babesiosis, ch.174 in Harrison´s Principles of Internal Medicine 13th ed. 1994; 890.
I completely agree with respect to the role of hemolysis of red blood cells that contain Plasmodia as well as with extravascular RBCs distruction in spleen. Regarding the suppression of the bone marrow, this event may be evocated for the chronic malaria only(anemia of inflammation), instead in the initial phases of disease the anemia is hyper-regenerative (increase of reticulocytes count).