title: Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis.
abstract: The efficacy of exchange transfusion as an adjunct treatment for severe falciparum malaria is controversial. No sufficiently powered, randomized, controlled study has been reported. We analyzed 8 studies that compared survival rates associated with adjunct exchange transfusion with those associated with antimalarial chemotherapy alone. Exchange transfusion was not associated with a higher survival rate than was antimalarial chemotherapy alone (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.7-2.1). However, patients who received transfusions had higher levels of parasitemia and more-severe malaria. Sensitivity analysis found that survival rates were higher among patients with partial immunity to malaria (OR, 0.5; 95% CI, 0.2-1.2) than they were among patients with no immunity (OR, 2.1; 95% CI, 0.9-4.8; P=.007). Exchange transfusion does not appear to increase the survival rate; however, there were significant problems with the comparability of treatment groups in the studies reviewed, and a randomized controlled trial is necessary to determine whether exchange transfusion is beneficial.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814-4799 , USA. riddler@pol.net
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
authors.forename: John W
authors.initials: JW
authors.lastname: Sanders
authors.forename: David L
authors.initials: DL
authors.lastname: Blazes
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D005078:Exchange Transfusion, Whole Blood; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D010963:Plasmodium falciparum; D015996:Survival Rate
chemical_list: D000962:Antimalarials