Exchange transfusion in severe falciparum malaria.

Malaria associated with complications or a fatal outcome is caused by Plasmodium falciparum. The mortality due to this disease is parallel to the degree of parasitemia. Successful use of exchange blood transfusion as a therapeutic adjunct for this infection was reported. The rationale for this form of therapy is based on (1) rapid reduction in parasite load by exchange transfusion, (2) removal of toxic substances and (3) reducing microcirculatory sludging. We describe here thirteen cases of severe falciparum malaria treated with infusion of quinine dihydrochloride and exchange transfusion 2,320-8,000 ml of whole blood. We observed that the greatest reduction in the average circulating infected red blood cells, from 20.7 per cent to 9.3 per cent, seemed to occur early in the first 2,000 ml of blood exchange and the parasitemia often reduced to 5.1 per cent in patients who had 4,000 ml of blood exchange. In order to reduce the initial parasitemia to 5 per cent by exchange transfusion, we suggest the volume of exchange transfusion should be 2,000 ml for average parasitemia 10 per cent, 4,000 ml for parasitemia > 20 per cent and 2,000-4,000 ml for parasitemia 10-20 per cent.

Diencephalic epilepsy resembling pheochromocytoma: a first reported case in Thailand.

A 31 year old hypertensive patient suffered from a fluctuation of blood pressure. Pheochromocytoma was suspected because of the clinical history, and extremely labile blood pressure but did not respond to therapy with alpha adrenergic blocking agent and normal excretion rates of catecholamine and vanilly mandelic acid (VMA). An enlarged left adrenal gland from computerized tomographic scan was found. So left adrenalectomy was performed and the result was consistent with cortical adrenal hyperplasia. Fluctuation of blood pressure still occurred after surgery with the symptoms of epigastric oppression and focal epileptic attack of the left arm. Epileptic potential waves were seen during hyperventilation from electroencephalogram but showed normal magnetic resonance imaging computerized tomographic scan of the brain. Diencephalic epilepsy was diagnosed and treated with anticonvulsant (carbamazepine) and eventually all of the symptoms including labile blood pressure subsided.