Interactive clinical case reports

Macallan, Derek C.; Pocock, Michaela; Robinson, Grant T.; Parker-Williams, John; Bevan, David

doi:10.1016/s0035-9203(00)90101-9

Cited by 31 publications

(6 citation statements)

References 9 publications

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“…RBC exchange has been advocated as a better alternative to whole blood exchange transfusion in the adjunctive treatment of severe imported malaria [ 14 – 16 ]. RBC exchange does not remove plasma toxins, but has significant advantages over exchange transfusion in terms of speed, efficiency, haemodynamic stability and retention of plasma components such as clotting factors and may thus represent an improvement in adjunctive therapy for severe malaria [ 17 ]. Although RBC exchange it is recommended by some national apheresis societies [ 18 ], conclusive evidence is lacking.…”

Section: Introductionmentioning

confidence: 99%

The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre

Calvo-Cano

Gómez-Junyent

Lozano

et al. 2016

Malar J

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BackgroundIntravenous artesunate has replaced quinine as the first-line therapy for severe imported malaria, given its anti-malarial superiority shown in clinical trials conducted in endemic countries. Evidence for red blood cell (RBC) exchange in patients with severe malaria treated with artesunate is lacking. This retrospective cohort study describes the experience at Hospital Clinic of Barcelona with the use of artesunate for severe malaria and the joint use of RBC exchange in selected cases.MethodsPatients treated for severe malaria at Hospital Clinic of Barcelona between August 2013 and January 2015 were included in this retrospective study. Severe malaria was defined according to WHO criteria. Data were extracted from electronic hospital records. A log-linear mixed model approach was used to estimate parasite clearance times.ResultsWithin the study period, 42 patients were diagnosed of malaria at this centre, of which 38 had Plasmodium falciparum (90.5 %). Sixteen patients (42 %) had severe malaria cases and were treated with intravenous artesunate. Four patients underwent RBC exchange within a period of 15 h after the first dose of artesunate (range 9–21 h). The procedure lasted a median of 2 h (IQR 1.8–2 h), using a median of 12 (IQR 11–14) units of packed RBCs to replace a median of 3794 ml (IQR 2977–4343). The technique was well-tolerated without haemodynamic complications. There were no deaths. The regression model showed an estimated time to 95 % decay of 21.6 h (95 % CI 17.3–28.8). When assessing effect modification by RBC exchange, there was no difference in the parasite elimination rate (p = 0.286).Discussion and conclusionIn this study RBC exchange failed to show benefits in terms of parasite clearance probably due to the small number of patients analysed. The evidence for exchange transfusion remains limited.

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Section: Introductionmentioning

confidence: 99%

The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre

Calvo-Cano

Gómez-Junyent

Lozano

et al. 2016

Malar J

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“…Whereas the reported experience with automated RBC exchange is comparable to previous case reports [12-17], the reporting of patient cohorts puts this adjunctive treatment in perspective by providing information about the proportion of patients undergoing this procedure at the Medical University of Vienna. Since randomized controlled trials are unlikely to be conducted in the near future, further cohort studies are the best way forward to increase the still limited knowledge and experience with this adjunctive treatment at this stage.…”

Section: Discussionmentioning

confidence: 53%

“…The efficacy of physical removal of parasites was shown by rapid clearance of peripheral parasitaemia. Despite the exchange volume of approximately 1–1.5 times of patients total RBC pool, apheresis did not lead to problems in fluid overload and haemodynamic distress, a phenomenon which was more frequently observed in patients undergoing whole blood exchange transfusion [17-19]. Moreover, during or shortly after automated RBC exchange no specific medical intervention became necessary to maintain haemodynamic and respiratory stability.…”

Section: Discussionmentioning

confidence: 99%

“…With this procedure, RBCs are separated automatically from the patient’s whole blood, while plasma, platelets and white blood cells are retained. This procedure is known to be better tolerated in various indications compared to whole blood exchange transfusion with regards to volume alterations, coagulation and electrolyte disturbances, and susceptibility to infection [17-19]. RBC exchange has been successfully used in patients with sickle cell crises [20] and has been advocated as adjunctive treatment option for severe malaria.…”

Section: Introductionmentioning

confidence: 99%

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Automated red blood cell exchange as an adjunctive treatment for severe Plasmodium falciparum malaria at the Vienna General Hospital in Austria: a retrospective cohort study

Auer-Hackenberg

Staudinger

Bojic

et al. 2012

Malar J

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BackgroundSevere falciparum malaria is associated with considerable rates of mortality, despite the administration of appropriate anti-malarial treatment. Since overall survival is associated with total parasite biomass, blood exchange transfusion has been proposed as a potential method to rapidly reduce peripheral parasitaemia. However, current evidence suggests that this treatment modality may not improve outcome. Automated red blood cell exchange (also referred to as “erythrocytapheresis”) has been advocated as an alternative method to rapidly remove parasites from circulating blood without affecting patients’ volume and electrolyte status. However, only limited evidence from case reports and case series is available for this adjunctive treatment. This retrospective cohort study describes the use of automated red blood cell exchange for the treatment of severe malaria at the Medical University of Vienna.MethodsEpidemiologic data for imported malaria cases in Austria are reported and data of patients treated for malaria at the General Hospital/Medical University of Vienna were extracted from electronic hospital records.ResultsBetween 2000 and 2010, 146 patients were hospitalized at the Medical University of Vienna due to malaria and 16 of those were classified as severe malaria cases. Eleven patients of this cohort were potentially eligible for an adjunctive treatment with automated red blood cell exchange. Five patients eventually underwent this procedure within a period of seven hours (range: 3–19 hours) after hospital admission. Six patients did not undergo this adjunctive treatment following the decision of the treating physician. The procedure was well tolerated in all cases and rapid reduction in parasite counts was achieved without occurrence of haemodynamic complications. One patient died within seven days, whereas four patients survived without any sequelae.Discussion and conclusionAutomated red blood cell exchange was a safe and efficient procedure to rapidly clear peripheral parasitaemia. Whether the fast reduction in parasite biomass may ultimately improve patient survival remains however unclear. Randomized controlled trials are needed to conclusively appreciate the value of this adjunctive treatment.

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“…Ongoing through the abstracts, only 6 articles found to report on exchange transfusion in malaria in children[ 22 23 24 25 26 27 ] Strategy 2: Erythrocytapheresis AND malaria yielded 3 relevant results. [ 28 29 30 ] …”

Section: Methodsmentioning

confidence: 99%

Exchange transfusion in complicated pediatric malaria: A critical appraisal

Barman

2015

Indian Journal of Critical Care Medicine

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Complicated falciparum malaria is a killer disease resulting in high mortality in spite of appropriate treatment. Some workers have reported improved survival when adjunct exchange blood transfusion is included in the treatment modality while others opine against it. This review is an effort to address and critically appraise current evidence for the treatment mode for severe malaria. The literature was searched with a specified search strategy to identify reports of children who underwent exchange transfusion for severe malaria. Total 23 children who underwent exchange transfusion for severe falciparum malaria published by 9 authors were identified. Age ranged from 5 months to 16 years with a mean age of 6.4 years. The average preprocedure parasite index (PI) was 41.4% (95confidence interval [CI]; 31.2-51.4). The average blood volume exchanged was 118.6% (95% CI; 94.7-143) of the circulating blood volume. The average postexchange reduction in PI was 34.1% (95% CI; 25.4-42.8). Three out of 23 children encountered some complications. All the children survivedKeywords: Exchange blood transfusion, parasite index, pediatric Intensive Care Unit, red cell exchange, severe falciparum malaria.

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Interactive clinical case reports

Cited by 31 publications

References 9 publications

The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre

The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre

Automated red blood cell exchange as an adjunctive treatment for severe Plasmodium falciparum malaria at the Vienna General Hospital in Austria: a retrospective cohort study

Exchange transfusion in complicated pediatric malaria: A critical appraisal

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