Manual blood exchange transfusion does not significantly contribute to parasite clearance in artesunate-treated individuals with imported severe Plasmodium falciparum malaria

Abstract

BackgroundExchange transfusion (ET) has remained a controversial adjunct therapy for the treatment of severe malaria. In order to assess the relative contribution of ET to parasite clearance in severe malaria, all patients receiving ET as an adjunct treatment to parenteral quinine or to artesunate were compared with patients treated with parenteral treatment with quinine or artesunate but who did not receive ET. ET was executed using a standardized manual isovolumetric exchange protocol.MethodsAll patients in the Rotterdam Malaria Cohort treated for severe P. falciparum malaria at the Institute for Tropical Diseases of the Harbour Hospital between 1999 and 2011 were included in this retrospective follow-up study. Both a two-stage approach and a log-linear mixed model approach were used to estimate parasite clearance times (PCTs) in patients with imported malaria. Severe malaria was defined according to WHO criteria.ResultsA total of 87 patients with severe malaria was included; 61 received intravenous quinine, whereas 26 patients received intravenous artesunate. Thirty-nine patients received ET as an adjunct treatment to either quinine (n = 23) or artesunate (n = 16). Data from 84 of 87 patients were suitable for estimation of parasite clearance rates. PCTs were significantly shorter after administration of artesunate as compared with quinine. In both models, ET did not contribute significantly to overall parasite clearance.ConclusionManual exchange transfusion does not significantly contribute to parasite clearance in artesunate-treated individuals. There may be a small effect of ET on parasite clearance under quinine treatment. Institution of ET to promote parasite clearance in settings where artesunate is available is not recommended, at least not with manually executed exchange procedures.

UK malaria treatment guidelines 2016

“…The rapid action of artesunate in reducing parasite burden means that any benefit of exchange transfusion is likely to be substantially reduced. 78 Current opinion is that exchange transfusion is now no longer indicated in severe malaria (Grade 2C). Routine blood transfusion may be indicated in those with symptomatic anaemia.…”

Red blood cell exchange in treatment of severe cerebral P. falciparum malaria: A case report

“…However, it should be noted that the average parasitemia reported (12.5%) was significantly lower than our patient's (53.33%). Hence, while several studies have recently cast doubt regarding the usefulness of RBC exchange transfusion treatment of severe malaria in comparison to artesunate based therapies alone, this case report indicates exchange transfusion may be helpful in treatment of P. falciparum malaria with extremely high parasite loads.…”

“…Red blood cells exchange transfusions have shown to be safe and effective in several case reports and small clinical trials . Unfortunately, no large scale randomized clinical trials comparing RBC exchange transfusion as an adjunct therapy for malaria have been conducted to date, and this type of treatment as an adjunct therapy for severe P. falciparum remains controversial …”

“…[6][7][8] Unfortunately, no large scale randomized clinical trials comparing RBC exchange transfusion as an adjunct therapy for malaria have been conducted to date, and this type of treatment as an adjunct therapy for severe P. falciparum remains controversial. [9][10][11] All work for this article was performed at Loma Linda University.…”

Exchange Transfusion for Severe Imported Falciparum Malaria with Hyperparasitaemia: Case Report

“…Small beneficial effect of manual ET on parasite clearance determined in quinine group however no benefit found in artesunate group. 15 We could provide artesunate to our patient after ET procedure.…”