Exchange transfusion in children with severe falciparum malaria and heavy parasitaemia

Abstract

While exchange transfusion has been advocated as an adjunctive treatment in severe falciparum malaria complicated by heavy parasitaemia, its role in severe life-threatening disease refractory to standard life support measures is less well recognised. We describe four children with severe falciparum malaria, multi-system involvement and heavy parasitaemia in whom we undertook exchange transfusion because of their deteriorating clinical condition despite antimalarials and supportive therapy. All patients received quinine (one also received artesunate). All patients improved dramatically following the procedure, with subsequent complete clinical recovery.

Ciddi Falciparum Sıtmasında Eritrosit Süspansiyonu ile Kan Değişimi Kararı ve Klinik Seyir Üzerine Etkileri: Olgu Sunumu

“…Ventricular arrhythmia, hypotension, hypoglycemia, and prolonged QT restrict the use of IV quinine (10). In cases of severe falciparum malaria, clinical deterioration is almost always observed along with cerebral involvement, renal dysfunction, and hyperparasitemia (4,5). Cerebral involvement in falciparum malaria increases mortality by 30%, while this rate can increase up to 80% with renal or respiratory failure (11).…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…The risks of exchange transfusion include fluid overload, febrile and allergic reactions, metabolic disturbances (e.g., hypocalcaemia), red blood cell alloantibody sensitization, blood-borne transmissible infection, and line sepsis. 20–22 The parasite density should be monitored every 12 hours until it falls below 1%, which usually requires the exchange of 8 to 10 units of blood in adults.…”

Parasitic disorders

“…The role of exchange transfusions in the management of cerebral malaria is controversial, but most authorities recommend them if the parasitemia is greater than 10% or in patients who are deteriorating in spite of conventional treatment (Shanbag et al, 2006). The role of exchange transfusions in the management of cerebral malaria is controversial, but most authorities recommend them if the parasitemia is greater than 10% or in patients who are deteriorating in spite of conventional treatment (Shanbag et al, 2006).…”