Considerations on the use of adjunct red blood cell exchange transfusion in the treatment of severe <i>Plasmodium falciparum</i> malaria

Shelat, Suresh G.; Lott, Jason P.; Braga, Matthew

doi:10.1111/j.1537-2995.2009.02530.x

Cited by 21 publications

(16 citation statements)

References 44 publications

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“…However, there are issues to be addressed with both procedures. Ensuring the quality of microscopy used for routine diagnosis has often proved difficult as the sensitivity and specificity of routine microscopy is significantly lower when compared with that of qualified microscopists based in reference laboratories [13]. This underlies the need for good training in microscopy for staff in remote areas.…”

Section: Discussionmentioning

confidence: 99%

“…In a series of parasite dilutions, studies have found that thick films tended to measure parasite densities around one log lower than the number calculated to be in the dilution and this did not vary by microscopist [13,19]. O’Meara et al [19] have shown that parasitaemia from the thick smear averaged 10% lower than the total mean ( p = 0.001) and they have also shown that white blood cells were much less uniformly distributed that the parasites.…”

Section: Discussionmentioning

confidence: 99%

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Inter-observer agreement according to malaria parasite density

Billo¹,

Diakité

Dolo

et al. 2013

Malar J

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BackgroundRecent developments in diagnostic techniques for malaria, particularly DNA probes and sero-immunology, have raised questions as to how these techniques might be used to facilitate malaria diagnosis at the most peripheral levels of the primary health care system. At present, malaria diagnosis is based on the standard microscopic examination of blood films in most field epidemiologic studies and is likely to remain so in the immediate future in Africa. The objective of this study was to assess inter-observer agreement for the examination of Giemsa-stained slides for Plasmodium falciparum parasites.MethodsChildren aged 0 to 10 years were enrolled yearly in Bancoumana village (West Africa), mainly during the transmission season (June to October). The blood smears obtained from the persistently negative children in June 1996, August 1996, October 1996 and March 1997 were systematically re-examined. A stratified random sample (10%) proportional to the following parasite density classes 1–100, 101–5000, and 5001 and over was taken from the slides collected. The kappa statistics and the intra-class correlation were used as measures of agreement the first and the second slide examinations.ResultsThe weighted kappa statistic, widely used as a chance-corrected measure for nominal agreement, showed excellent inter-observer agreement (κw=0.7926; 95% CI [0.7588, 0.8263]; p=0.01). The intra-class correlation co-efficient had the same value of 0.7926 confirming the appropriateness of the weighted kappa statistic. Inter-observer agreement for slides read as negative by one observer, or as containing more than 100 parasites per μl, was excellent: 97% (493/506) and 92% (145/158), respectively. In contrast, the inter-observer agreement for slides read by one observer as containing 1–100 parasites/μl was poor, 36% (96/268).ConclusionsIn field conditions in Mali, there was a high reproducibility for slides reported as negative or as having more than 100 parasites per μl. However, smears with readings of 1–100 parasites per μl were less reproducible and should be re-examined carefully.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inter-observer agreement according to malaria parasite density

Billo¹,

Diakité

Dolo

et al. 2013

Malar J

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“…In severe malaria, RCET is a treatment option considered in case of hyperparasitemia, organ failure, and resistance to treatment (13)(14)(15). Studies show that sepsis can decline with decreased parasite load through RCET (16)(17)(18). Our case had a parasite load of 25% and had developed septic shock within hours despite mefl oquine and doxycycline treatment.…”

Section: Discussionmentioning

confidence: 91%

Ciddi Falciparum Sıtmasında Eritrosit Süspansiyonu ile Kan Değişimi Kararı ve Klinik Seyir Üzerine Etkileri: Olgu Sunumu

Güçyetmez¹,

Ogan²,

Rasimoğlu³

et al. 2013

tybdd

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SUMMARY Red cell exchange transfusion (RCET) is a treatment option for severe falciparum malaria, which reduces the parasite load and toxemia. Pulmonary edema, metabolic changes, hyperkalemia, arrhythmia, hypocalcemia due to citrate toxicity, rebound hypoglycemia, hypothermia, anaphylactic reactions, hypotension or hypertension, thrombocytopenia, thrombo-embolism, coagulopathy, and necrotizing enterocolitis are the major acute phase RCET complications. In our case of severe falciparum malaria that was resistant to treatment; reduction in parasite load and sepsis was observed following RCET, but severe acute respiratory distress syndrome (ARDS) has developed. Key Words: Severe falciparum malaria, red cell exchange transfusion, acute respiratory distress sendrome (ARDS) ÖZET Eritrosit süspansiyonu ile kan değişimi (red cell exchange transfüzyon, RCET) ciddi falciparum sıtmasında parazit yükü ve toksemiyi azaltmak için uygulanan bir tedavi seçeneğidir. Pulmoner ödem, metabolik değişiklikler, hiperkalemi, aritmi, sitrat toksisitesine bağlı hipokalsemi, rebound hipoglisemi, hipotermi, anafl aktik reaksiyonlar, hipotansiyon veya hipertansiyon, trombositopeni, tromboembolizm, koagülopati ve nekrotizan enterokolit RCET uygulamasının erken döneminde görülebilen majör komplikasyonlardır. Tedaviye direnç gelişmiş ciddi falciparum tanılı olgumuzda, RCET sonrası parazit yükü ve septik tabloda gerileme olmasına rağmen ciddi akut respiratuar distres sendromu (ARDS) gelişmiştir.Anah tar Ke li me ler: Ciddi falciparum sıtması, eritrosit süspansiyonu ile kan değişimi, akut respirator distres sendromu (ARDS)

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confidence: 99%

“…[17][18][19] ET has been proposed as an adjunctive anti-malarial treatment to remove infected red blood cells from circulation, thereby lowering the parasite burden. 20,21 Other mechanisms may involve the removal of toxic substances, reducing microcirculatory sludging, and increasing the oxygen-carrying capacity of the blood. 22 WHO, however, suggested that the lack of consensus on the indications, benefits, dangers, and practical details of the procedure make it impossible to reach any conclusions regarding the use of this procedure.…”

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confidence: 99%

Successful Treatment of Severe Falciparum Malaria With Adjunctive Use of Exchange Transfusion

AlJohani¹,

Davis

2013

DMJ

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A frequent traveller to malaria-endemic areas, a 50-yearold Canadian, without a significant medical history, returned from a 4-week trip to Nigeria. His malaria chemoprophylaxis was stopped prematurely due to side effects. During the trip, he adopted appropriate measures to prevent mosquito bites and was up-todate on his vaccinations. Four days after returning to Canada, he became ill; his symptoms included fever, chills, sweating, headache, and joint pains, followed by diarrhea, jaundice, shortness of breath, and a noticeable darkening of urine.He presented to a local hospital's emergency department where malaria was suspected; thin/thick blood smears confirmed an infection by Plasmodium falciparum. The parasitemia level was markedly high at 26%. Upon admission, he was in respiratory distress; his temperature was 38 °C, heart rate 118 beats/minute, blood pressure 110/70 mm Hg, respiratory rate 28/ minute, and oxygen saturation level 94%, using a 40% FIO2 face mask. The patient's physical examination revealed icterus, fine bilateral inspiratory crackles, tachycardia, and mild tender hepatomegaly. Figure 1 shows two peripheral blood smears taken from the patient which demonstrate red blood cells heavily infected with malaria parasites.The time between confirmation of his malaria diagnosis and the start of malaria treatment was approximately 1 hour. The patient's complete blood count showed a leukocyte count of 7. The patient's condition deteriorated rapidly in the emergency department, prior to admission to the critical care unit, where he was intubated, sedated, mechanically ventilated, and started on intravenous artesunate (2.4 mg/kg). A repeat chest x-ray revealed signs of acute respiratory distress syndrome (ARDS). Artesunate was re-administered at 12, 24, and 48 hours after the first dose.His hemoglobin levels dropped to 60 g/L, and his platelet count remained very low (12×10 3 /µL), necessitating multiple blood and platelet transfusions. A manual exchange transfusion (ET) was done within the first 24 hours, replacing 3000 mL of blood with 3517 mL; the duration of the ET was 8 hours.His renal function worsened, resulting in acute kidney failure, which required urgent hemodialysis. The patient's blood cultures were positive for Streptococcus pneumoniae and methicillin-sensitive Staphylococcus aureus. He was started on ceftriaxone (1 g intravenously daily), which was stepped down to amoxicillin/ clavulanic acid, based on culture sensitivities. CASE REPORT AbstractAlthough malaria is no longer endemic in Canada, it remains an important imported disease, principally among immigrants and travellers. The role of exchange transfusion in malaria treatment, in addition to standard anti-malarial treatment, remains controversial and is not well established. We report a case of severe malaria in a male traveller, complicated by multiorgan failure, septic shock, myositis, and unusual Streptococcus pneumoniae bacteremia. Manual exchange transfusion was used, in addition to artesunate-based therapy, and the patient respo...

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Considerations on the use of adjunct red blood cell exchange transfusion in the treatment of severe Plasmodium falciparum malaria

Cited by 21 publications

References 44 publications

Inter-observer agreement according to malaria parasite density

Inter-observer agreement according to malaria parasite density

Ciddi Falciparum Sıtmasında Eritrosit Süspansiyonu ile Kan Değişimi Kararı ve Klinik Seyir Üzerine Etkileri: Olgu Sunumu

Successful Treatment of Severe Falciparum Malaria With Adjunctive Use of Exchange Transfusion

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