Exchange transfusion therapy in severe complicated malaria.

Two groups of sixteen cases of severe complicated falciparum malaria on two different regimens of treatment were retrospectively studied. The first group including 12 patients, were treated by anti malarial drugs alone. The second group including 4 patients, were treated by exchange transfusion. Multisystemic complications were observed in both groups. It was observed that in complicated Acute Respiratory Distress Syndrome (ARDS), renal and hyperparasitemia were > 30 per cent. The result of the exchange transfusion group was superior to the non exchange group. Exchange transfusion is therefore recommended in the treatment of malarial patients who present with parasitemia > 30 per cent and severe multisystemic complications particularly those who have severe acute renal failure or have lung complications. The amount of blood used for each exchange transfusion should be at least 10-14 units for rapid removal of parasites and toxic metabolites from the circulation.

Exchange transfusion therapy in severe complicated malaria.

Nine cases of severe complicated falciparum malaria treated by exchange transfusion were studied. Eight patients survived and one patient died. Multisystemic complications were found in all cases. The CNS complications, acute renal failure, pulmonary insufficiency, jaundice, bleeding, sepsis, and DIC were found in 9, 7, 5, 7, 2, 4 and 1 cases, respectively. The fatal case presented with severe multisystemic complications together with 40% parasitemia. In eight survivors, whose parasitemia ranged from 0.3%, to 90%, had milder degrees of systemic complications. With the use of blood exchange 10-15 units, the parasitemia was decreased to less than 5% within 24 hours in all expect one who had parasitemia 90%. In comparison with the other 10 matched non-exchanged patients, there was no significant difference in survival rate between these two group (89% vs 80%). However, in the patients with ARDS the survival rate in the group who received the exchange transfusion therapy was superior (75% vs 0%). The exchange transfusion therapy is therefore strongly recommended in the treatment of malarial patients who present with parasitemia > 30% and severe systemic complications, particularly those who have severe acute renal failure or have lung complications. The amount of blood used for exchange transfusion should at least 1.2 times the blood volume for rapid removal of parasites and toxic metabolites from the circulation.