Automated erythrocytapheresis for severe falciparum malaria.
We describe a case of severe falciparum malaria with hyperparasitaemia. Treatment with automated erythrocytapheresis, in conjunction with parenteral artesunate, produced a rapid and sustained fall in parasite burden. Several poor prognostic features were present at admission. Despite the development of a severe headache with abnormal cerebrospinal fluid parameters and transient pulmonary oedema, a complete recovery was observed. Erythrocytapheresis can be considered in selected cases where facilities exist and has theoretical and practical advantages over traditional methods of red cell exchange transfusion. The paucity of systematic or trial evidence convincingly demonstrating a benefit in terms of morbidity or mortality has limited its application. However, the lack of robust trial data should not in itself invalidate considering this therapeutic option in the appropriate context.
Pathology QueenslandDepartments of Haematology and Oncology Department of Intensive Care Medicine, Townsville Hospital, Townsville, Queensland, Australia. patrick_harris@health.qld.gov.au
P
P
Harris
S
S
Price
S
S
Senthuran
J
J
Cochupanachimootil
R
R
Norton
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D001315:Australia; D001331:Automation; D001781:Blood Component Removal / Q000379:methods*; D002160:Cambodia; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000469:parasitology; D004983:Ethanolamines / Q000627:therapeutic use; D005449:Fluorenes / Q000627:therapeutic use; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000469:parasitology / Q000628:therapy*; D008297:Male; D018512:Parasitemia / Q000188:drug therapy / Q000469:parasitology / Q000628:therapy*; D014195:Travel
D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077332:Artesunate; D000077549:Artemether; D000078102:Lumefantrine