Abstract
BackgroundThis study was designed to evaluate the efficacy of exchange transfusion in patients with severe imported falciparum malaria. Twelve patients who met the diagnostic criteria for severe malaria were treated with exchange transfusion 14 times according to a conventional anti-malarial treatment. This study evaluated the efficacy of exchange transfusion for severe imported falciparum malaria.MethodsClinical data of severe imported falciparum malaria patients admitted to the intensive care unit (ICU) of Nantong Third People’s Hospital from January 2007 to December 2016 were investigated in this retrospective study. Patients were divided into the intervention group, which received exchange transfusion, and the control group. This study assessed parasite clearance and outcomes of the two groups, and levels of erythrocytes, haemoglobin, platelets, coagulation, liver function, lactate, C-reactive protein, and procalcitonin, before and after exchange transfusion in the intervention group.ResultsThere was no significant difference in the severity of admitted patients. Exchange transfusion was successfully applied 14 times in the intervention group. Differences in the levels of erythrocytes, haemoglobin and platelets did not reach statistical significance. Exchange transfusion improved coagulation, liver function, lactic acid, C-reactive protein, and procalcitonin. No differences were observed in parasite clearance, ICU and hospital length of stay, in-hospital mortality, and costs of hospitalization between the two groups.ConclusionExchange transfusion as adjunctive therapy for severe malaria was observed to be safe in this setting. Exchange transfusion can improve liver function and coagulation and reduce inflammation, but it failed to improve parasite clearance and the outcomes of severe imported falciparum malaria in this case series.
Highlights
This study was designed to evaluate the efficacy of exchange transfusion in patients with severe imported falciparum malaria
Many severe malaria patients who are admitted to an intensive care unit (ICU) have suffered from dysfunction in their liver, kidneys and other organs
Patient selection The inclusion criteria were: (1) hospital admission from January 2007 to December 2016; (2) a diagnosis of falciparum malaria based on a blood smear performed at the hospital and the centres for disease control and prevention; and, (3) meeting the severe malaria diagnostic criteria [4], which were defined as cerebral malaria characterized by impaired consciousness (Glasgow Coma Scale score < 11) or convulsions, circulatory collapse, acute respiratory distress syndrome, jaundice, along with other organ dysfunction, haemoglobinuria, spontaneous bleeding, hypoglycaemia, severe anaemia,metabolic acidosis, hyperlactataemia, acute kidney injury, and P. falciparum parasitaemia > 10%
Summary
This study was designed to evaluate the efficacy of exchange transfusion in patients with severe imported falciparum malaria. Twelve patients who met the diagnostic criteria for severe malaria were treated with exchange transfusion 14 times according to a conventional anti-malarial treatment. This study evaluated the efficacy of exchange transfusion for severe imported falciparum malaria. Many severe malaria patients who are admitted to an intensive care unit (ICU) have suffered from dysfunction in their liver, kidneys and other organs. The incidence of severe malaria was 10% in imported falciparum malaria. Advances in the care of severe imported falciparum. Lin et al Malar J (2018) 17:32 evaluated the efficacy of exchange transfusion for severe imported falciparum malaria
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