Can therapeutically-rational exchange (T-REX) of type-O red blood cells (RBCs) benefit Plasmodium falciparum malaria patients?

Therapeutically‐rational exchange (T‐REX) of Gerbich‐negative red blood cells can be evaluated in Papua New Guinea as “a rescue adjunct” for patients with Plasmodium falciparum malaria

“…21 Now, to optimize exchange-formalaria, we have recommended that T-REX be evaluated. [5][6][7][36][37][38][39] Fortunately, in 1981, a clinical study that evaluated exchange transfusions of two different malaria-resistant RBC variants was successfully conducted by pediatricians in Nigeria. 40 Given the advances in medical care since 1981, evaluation of T-REX is surely feasible in PNG decades after exchange transfusions of malaria-resistant RBC genetic variants proved to be both safe and effective in sub-Saharan Africa.…”

“…2 Relevant to their recommendation, physicians are promoting evaluation of T-REX of malaria-resistant RBC variants; and, fortunately, GN therapeutically-rational exchange transfusion (T-REX) should be safe and feasible in PNG given the success of exchange transfusions of malaria-resistant RBC genetic variants in Nigeria. [5][6][7][36][37][38][39][40] Presumably reassuring for clinicians in PNG, researchers have noted (a) PNG is an ideal setting for GN research, (b) GN RBCs seem to protect against severe Pf malaria, and (c) clinical studies of GN RBCs in PNG have been recommended. [2][3][4] With hospital support and technical assistance from blood bank and transfusion medicine specialists, clinicians in PNG have the opportunity to evaluate T-REX of GN RBCs as "a rescue adjunct" for patients with severe Pf malaria.…”

“…To avoid confusion that can be caused by different terms that are essentially synonymous, here we use terms adopted in past publications. [1][2][3][4][5][6][7] The malaria-resistant Gerbich-negative (GN) red blood cell (RBC) variant known as "the GN phenotype" is often called "GYPCΔex3" because the GN phenotype is encoded by the GYPC gene with exon 3 deletion. 3 For example, in an article describing the protection provided by the GN phenotype, Zimmerman et al noted: "it is clearly important to investigate how GYPCΔex3 influences malaria pathogenesis".…”

“…Regarding exchange-transfusion terms, exchange of malaria-resistant GN RBCs can be called "therapeutically-rational exchange" (T-REX) of GN RBCs or GN T-REX. [5][6][7] The special acronym "T-REX" was created because clinicians may not appreciate that, for more than 40-years, all exchange transfusions for Pf-malaria patients had transfused nondescript "standard issue" units of RBCs that randomly delivered malaria-susceptible RBCs that can promote Pf-disease progression. Because T-REX refers to exchanging only malaria-resistant RBCs, the clinical impact of T-REX might differ substantially from that of conventional "standard issue" exchange.…”

The Centers for Disease Control and Prevention and State Health Departments should include Blood-Type Variables in their Babesiosis Case Reports

“…Public health officials should be aware that researchers have recommended that malaria-resistant RBCs be used when Pf-malaria patients need simple or exchange transfusion. [16][17][18][19][20][21][22] Since the pathogenesis of babesiosis is also likely to be affected by RBC-related variables, it seems prudent to report the RBC variables of babesiosis patients -and of the donors when transfusion is used to https://doi.org/10.1016/j.transci.2020. Perhaps this disparity in RBC-related research is because the number of babesisosis cases is small compared to the estimated 228 million [23] cases of malaria in year 2018.…”