Current evidence and future of automated erythrocyte exchange in the treatment of severe malaria.
Despite the administration of antimalarial treatment, severe malaria still has a high mortality rate. Since overall survival is associated with total parasite biomass, whole blood exchange (e.g. blood exchange transfusions) has been proposed as a potential method to rapidly reduce peripheral parasitaemia. Automated red blood cell exchange has been advocated as a physical method to remove parasites. Compared to exchange transfusion, automated red blood exchange may avoid the risk of volume alterations and haemodynamic distress. Since 1984, there have been 37 published cases in which automated red blood cell exchange was used as an adjunctive treatment in severe malaria caused by Plasmodium falciparum. This short review summarizes current evidence and discusses problems, challenges and goals for future studies and research in order to assess the clinical benefit of automated erythrocyte exchange in severe malaria cases.
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1190 Vienna, Austria.
Lorenz
L
Auer-Hackenberg
Stefan
S
Winkler
Wolfgang
W
Graninger
Nina
N
Worel
Michael
M
Ramharter
D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005078:Exchange Transfusion, Whole Blood / Q000706:statistics & numerical data*; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome