Interactive clinical case reports: Red cell exchange, erythrocytapheresis, in the treatment of malaria with high parasitaemia in returning travellers
✍ Scribed by Derek C. Macallan; Michaela Pocock; Grant T. Robinson; John Parker-Williams; David H. Bevan
- Book ID
- 104165879
- Publisher
- Elsevier Science
- Year
- 2000
- Tongue
- English
- Weight
- 551 KB
- Volume
- 94
- Category
- Article
- ISSN
- 0035-9203
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✦ Synopsis
In severe falciparum malaria with high parasitaemia, removal of parasitized erythrocytes is generally considered to be of value as adjunctive therapy in addition to standard chemotherapy. Such removal is commonly achieved by exchange transfusion but this procedure is time-consuming and may be associated with haemodynamic disturbance. Current-generation automated cell-separator hardware and software allows prompt red cell exchange, erythrocytapheresis, in a single continuous-flow isovolaemic procedure. We describe the application ofthls procedure to 5 cases of severe falciparum malaria in travellers returning to the UKfrom the tropics. All patients also received quinine and conventional supportive therapy. In all cases, dramatic reduction in parasitaemia was achieved within 2 h with subsequent complete clinical recovery. Erythrocytapheresis has significant advantages over exchange transfusion in terms of speed, efficiency, haemodynamic stability and retention ofplasma components such as clotting factors and may thus represent an improvement in adjunctive therapy for severe malaria.