Automated RBC exchange transfusion:treatment for cerebral malaria.
BACKGROUND
Cerebral malaria is a life-threatening complication of Plasmodium falciparum infection. RBC exchange transfusion can reduce the level of parasitemia in this setting. Experience with automated RBC exchange for cerebral malaria may be limited, as most cases occur when the necessary equipment and blood components are not readily available.


METHODS
Three patients were admitted with cerebral malaria. Parasites were found in more than 30 percent of RBCs in two cases and in more than 60 percent of RBCs in the third case. Many RBCs contained multiple organisms. In each case, antimalarial therapy was begun, and an automated RBC exchange was performed emergently with a cell separator. Exchange transfusion was repeated within 24 hours for two patients. Parasitemia levels were less than 1 percent in all patients 24 hours after the last exchange. The neurologic status of these patients returned to baseline, and they were discharged 7 to 18 days after admission.


CONCLUSIONS
Automated RBC exchange transfusion can rapidly reduce the level of parasitemia and restore neurologic functioning in patients with cerebral malaria.
Weir
E G
EG
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
King
K E
KE
Ness
P M
PM
Eshleman
S H
SH
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D001331:Automation; D003131:Combined Modality Therapy; D004318:Doxycycline / Q000008:administration & dosage; D004641:Emigration and Immigration; D004912:Erythrocytes / Q000469:parasitology*; D005078:Exchange Transfusion, Whole Blood / Q000379:methods*; D005260:Female; D005869:Ghana / Q000208:ethnology; D006400:Hematocrit; D006801:Humans; D007630:Kenya; D016779:Malaria, Cerebral / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D009549:Nigeria / Q000208:ethnology; D010100:Oxygen / Q000627:therapeutic use; D018512:Parasitemia / Q000097:blood / Q000628:therapy*; D017713:Platelet Transfusion; D011802:Quinidine / Q000627:therapeutic use; D014195:Travel
D000962:Antimalarials; D011802:Quinidine; D004318:Doxycycline; D010100:Oxygen