Background: There are few publications on anemia following artesunate treatment. Objective: To investigate the hemoglobin in patients with severe Plasmodium falciparum malaria treated with artesunate or quinine. Methods: Patients with P. falciparum (in Singa, Sudan) were treated by intravenous artesunate or quinine. Hemoglobin was measured initially, at day 14 and day 28. Results: The mean (SD) of the age was 10.3 (10.9) years. The two groups (61 in each arm) were matched in their basic characteristics. Hypotension, convulsions, severe anemia were the main presentations. There was no significant difference in the mean (SD) hemoglobin level at the initial day, day 14 and at day 28 [11.2 (1.8), 11.3 (1.6), 11.5 (1.8), p = 0.170], respectively, in both groups. The hemoglobin did not change significantly from the baseline in any of the group separately. Conclusion: There was no difference in hemoglobin concentration in patients with severe malaria after treatment with either artesunate or quinine.