Red blood cell exchange in treatment of severe cerebral P. falciparum malaria: A case report

Abstract

Introduction: Red blood cells exchange transfusion has been demonstrated to be helpful in treatment of sever P. falciparum malaria. However, no large scale randomized controlled trials have been completed to date and the CDC does not recommend RBC exchange transfusions as standard of care. We present a case of severe cerebral malaria in a patient with extremely high parasitemia and severe altered mental status who improved rapidly with automated RBC exchange. Report: Seventy‐two year old female presented with 1 day history of weakness, altered mental status, malaise, and cyclic sweats after returning from a trip to Sierra Leone. Thick and Thin Smears demonstrated P. falciparum rings present and Quantitative malaria screen demonstrated 53.33% parasitemia. Patient was started on quinidine and doxycycline but continued to deteriorate. Automated RBC exchange transfusion was performed within 24 hours of admission and resulted in rapid improvement in symptomology. Repeat thick and thin smears revealed undetectable parasite load. Conclusion: Automated RBC exchange may improve outcomes in severe P. falciparum malaria when presenting parasite loads are very high.

Role of automated red blood cell exchange in the treatment of aluminum phosphide poisoning: A case report and review of the literature

“…Automated red blood cell exchange is a procedure during which a specified percentage of a patient's red cells are exchanged for those of a donor by means of an automated process called apheresis 10 . Automated red blood cell exchange has been successfully used in complications of sickle cell disease, hematopoietic stem cell transplantation, erythropoietic protoporphyria, red cell alloimmunization, and some infectious diseases like babesiosis and malaria 10‐13 . The purpose of applying ARCE therapy in these diseases is to reduce HbS concentration, removal of damaged erythrocytes or removal of parasite loaded erythrocytes and increase hemoglobin levels or intact erythrocytes in order to improve tissue perfusion 10,11 .…”

“…10 Automated red blood cell exchange has been successfully used in complications of sickle cell disease, hematopoietic stem cell transplantation, erythropoietic protoporphyria, red cell alloimmunization, and some infectious diseases like babesiosis and malaria. [10][11][12][13] The purpose of applying ARCE therapy in these diseases is to reduce HbS concentration, removal of damaged erythrocytes or removal of parasite loaded erythrocytes and increase hemoglobin levels or intact erythrocytes in order to improve tissue perfusion. 10,11 With a similar idea, we aimed to treat metabolic acidosis, tissue hypoxia and prevent the disseminated oxidative stress by removing the erythrocytes which are affected by AIP from the circulation in order to correct the patient's resistant hypotension and metabolic acidosis.…”

Successful Use of Adjunctive Red Blood Cell Exchange Therapy for Treatment of an Acute Hemolytic Reaction After ABO-Incompatible Red Blood Cell Transfusion

“…Red blood cell exchange therapy (RBCET) has been used to treat hemoglobinopathies such as sickle cell disease and thalassemia [4]. It has also been used to treat patients with malaria and babesiosis with heavy parasitemia [5]. To date, there are three previous reports [3,6,7] in the English-language literature of AHTR treated with adjunctive red blood cell exchange in an adult.…”