Exchange transfusion as an adjunct to the treatment of severe falciparum malaria.
OBJECTIVE
To compare the efficacy of exchange transfusion as the adjunct to quinine treatment (21 patients) with quinine therapy alone (29 patients).


METHODS
A retrospective study of 50 patients with severe falciparum malaria was conducted at Chumphorn Hospital, Southern Thailand.


RESULTS
Clinical characteristics in both treatment groups were not significantly different although in the exchange transfusion group, the admission geometric mean parasitaemia (18 (5%), and the proportion of patients with more than 10% parasitaemia was higher (76%, P = 0.03) than in the group who received quinine alone (10 +/- 4%; 38%, P = 0.1). The mortality rate of patients who received exchange transfusion was 48%; that of the remainder, 69%. (P = 0.3). ARDS (P = 0.01) and oliguric renal failure (P = 0.04) were significant risk factors for death in these patients.


CONCLUSIONS
Exchange transfusion was safe and well tolerated. Results of our study revealed a 20% reduction in mortality when exchange transfusion was used as an adjunct to quinine treatment. It should therefore be considered in patients with severe falciparum malaria when possible.
Hoontrakoon
S
S
Department of Medicine, Chumphorn Hospital, Thailand.
Suputtamongkol
Y
Y
D058186:Acute Kidney Injury / Q000469:parasitology; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000469:parasitology / Q000628:therapy*; D008297:Male; D011803:Quinine / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000469:parasitology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000962:Antimalarials; D011803:Quinine