Automated exchange transfusion for life-threatening plasmodium falciparum malaria—Lessons relating to prophylaxis and treatment

• Published in: The Journal of infection Vol. 39; no. 3; pp. 231 - 233
• Main Authors: Mainwaring, C.J., Leach, M.J., Nayak, N., Green, S.T., Jones, D.A., Winfield, D.A.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.11.1999; Elsevier
• Subjects: Adult; Biological and medical sciences; Exchange Transfusion, Whole Blood; Female; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Falciparum - prevention & control; Malaria, Falciparum - therapy; Medical sciences; mefloquine; Mefloquine - therapeutic use; parasitemia; Parasitemia - therapy; Parasitic diseases; Plasmodium falciparum; Protozoal diseases; quinine; Travel; Tropical medicine; Kidney disease; Human; Protozoa; Apicomplexa; Protozoal disease; Disseminated intravascular coagulopathy; Urinary system disease; Malaria; Erythrocytapheresis; Hemodialysis; Critically ill; Hemopathy; Parasitosis; Infection; Case study; Extrarenal dialysis; Plasmodium falciparum; Imported disease; Efficiency; Renal failure; Combined treatment; Parasitemia; Coagulopathy
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/S0163-4453(99)90055-5

We report a case of traveller to Kenya who contracted severe plasmodium falciparum malaria complicated by disseminated intravascular coagulation and acute renal failure. She had taken no antimalarial prophylaxis in view of concerns in the media regarding the adverse effects of melloquine. There was a protracted delay before the diagnosis of malaria was made. Clinical recovery occurred following treatment with intravenous quinine, haernofiltration and manual/automated red-cell exchange transfusions. Automated red-cell exchange transfusion resulted in a marked decrease in the parasitaemia, before a response to quinine therapy would have been anticipated, leading to a successful outcome thereafter. In conjunction with other groups we therefore feel that exchange transfusions should be considered in seriously ill patients with falciparum malaria, multiorgan complications and parasitaemias greater than 10%.