[Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients].
OBJECTIVE
The high mortality attributable to severe malaria by Plasmodium falciparum is related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternative to exchange transfussion, with the same potential benefits but less undesirable side effects. Literature on this technique is scarce, consisting of isolated reports or short series. The objective of this study is to describe the clinical picture and outcome observed in 6 severely ill malaria patients in whom EA was applied as complimentary therapeutic technique.


METHODS
An observational prospective descriptive study was carried out of all inpatients with severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiological and parsitological data were analyzed.


RESULTS
This series included 2 women and 4 men, with a median age of 43 years. In all cases, the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarial prophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between 10% and 35%. The number of severity criteria was between one and 4, the more frequent being hyperbilirrubinemia. All patients received conventional intravenous treatment. The total length of admission oscillated between 5 and 37 days, while the length of stay in the Intensive Care Unit varied between one and 17 days. All patients survived.


CONCLUSIONS
AE is a safe technique, with the same advantages that blood exchange but lacking many of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of 5% is associated with any additional World Health Organization-2000 criteria of clinical severity, should constitute an indication for AE.
Fernández-Fuertes
Luis-Fernando
LF
Servicio de Hematología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
Tapia-Martín
Manuel
M
Angel-Moreno
Alfonso
A
Pisos-Alamo
Elena
E
Losada-Castillo
M Carmen
MC
Díaz-Cremades
Juan-Manuel
JM
Pérez-Arellano
José-Luis
JL
D000328:Adult; D017954:Africa South of the Sahara; D000962:Antimalarials / Q000627:therapeutic use; D016238:Cytapheresis; D017707:Erythrocyte Transfusion; D004912:Erythrocytes; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis; D011446:Prospective Studies; D011803:Quinine / Q000627:therapeutic use; D012720:Severity of Illness Index; D013997:Time Factors; D014944:World Health Organization
D000962:Antimalarials; D011803:Quinine