title: Exchange transfusion for severe malaria.
abstract: BACKGROUND
  Exchange transfusion (ET) is a controversial ancillary treatment of severe falciparum malaria.
  
  
  METHODS
  We conducted a retrospective analysis of severe malaria treated in our institution. Nine cases of ET were identified between 1991 and 1998 and compared to 12 controls with similar parasitemia.
  
  
  RESULTS
  Groups were similar at admission except for an increased age in the ET group (p < 0.02). All patients received iv quinine. Outcome was similar in both groups (two deaths in the ET group, three in the control group). However, in patients with parasitemia > 30%, the death rate was significantly lower in ET patients than in controls (0/4 vs 3/3, p < 0.029).
  
  
  CONCLUSIONS
  Despite definitive data from controlled trials, we suggest that ET should be considered in severe malaria cases with very high parasitemia and severity criteria or worsening clinical condition despite adequate chemotherapy.
authors.affiliation: Dept of Infectious Diseases and Intensive Care, Centre Hospitalier, Tourcoing, France. alfandari@nordnet.fr
authors.forename: S
authors.initials: S
authors.lastname: Alfandari
authors.forename: G
authors.initials: G
authors.lastname: Dixmier
authors.forename: B
authors.initials: B
authors.lastname: Guery
authors.forename: O
authors.initials: O
authors.lastname: Leroy
authors.forename: H
authors.initials: H
authors.lastname: Georges
authors.forename: G
authors.initials: G
authors.lastname: Beaucaire
mesh_terms: D000328:Adult; D000368:Aged; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018512:Parasitemia; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome