title: Automated red blood cell exchange as an adjunctive treatment for severe Plasmodium falciparum malaria at the Vienna General Hospital in Austria: a retrospective cohort study.
abstract: BACKGROUND
  Severe falciparum malaria is associated with considerable rates of mortality, despite the administration of appropriate anti-malarial treatment. Since overall survival is associated with total parasite biomass, blood exchange transfusion has been proposed as a potential method to rapidly reduce peripheral parasitaemia. However, current evidence suggests that this treatment modality may not improve outcome. Automated red blood cell exchange (also referred to as "erythrocytapheresis") has been advocated as an alternative method to rapidly remove parasites from circulating blood without affecting patients' volume and electrolyte status. However, only limited evidence from case reports and case series is available for this adjunctive treatment. This retrospective cohort study describes the use of automated red blood cell exchange for the treatment of severe malaria at the Medical University of Vienna.
  
  
  METHODS
  Epidemiologic data for imported malaria cases in Austria are reported and data of patients treated for malaria at the General Hospital/Medical University of Vienna were extracted from electronic hospital records.
  
  
  RESULTS
  Between 2000 and 2010, 146 patients were hospitalized at the Medical University of Vienna due to malaria and 16 of those were classified as severe malaria cases. Eleven patients of this cohort were potentially eligible for an adjunctive treatment with automated red blood cell exchange. Five patients eventually underwent this procedure within a period of seven hours (range: 3-19 hours) after hospital admission. Six patients did not undergo this adjunctive treatment following the decision of the treating physician. The procedure was well tolerated in all cases and rapid reduction in parasite counts was achieved without occurrence of haemodynamic complications. One patient died within seven days, whereas four patients survived without any sequelae.
  
  
  CONCLUSIONS
  Automated red blood cell exchange was a safe and efficient procedure to rapidly clear peripheral parasitaemia. Whether the fast reduction in parasite biomass may ultimately improve patient survival remains however unclear. Randomized controlled trials are needed to conclusively appreciate the value of this adjunctive treatment.
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1190, Vienna, Austria.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Auer-Hackenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Gottfried
authors.initials: G
authors.lastname: Locker
authors.forename: Gerda C
authors.initials: GC
authors.lastname: Leitner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Graninger
authors.forename: Stefan
authors.initials: S
authors.lastname: Winkler
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
authors.forename: Nina
authors.initials: N
authors.lastname: Worel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001317:Austria; D001331:Automation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult