Journal of Emergencies, Trauma, and Shock
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Year : 2010  |  Volume : 3  |  Issue : 2  |  Page : 206
Erythrocytapheresis in the emergency management of severe falciparum malaria


Intensive Care Unit, Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria, Spain

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Date of Web Publication31-Mar-2010
 

How to cite this article:
Santana-Cabrera L, Arroyo MF, Gonzalez FR, Palacios MS. Erythrocytapheresis in the emergency management of severe falciparum malaria. J Emerg Trauma Shock 2010;3:206

How to cite this URL:
Santana-Cabrera L, Arroyo MF, Gonzalez FR, Palacios MS. Erythrocytapheresis in the emergency management of severe falciparum malaria. J Emerg Trauma Shock [serial online] 2010 [cited 2019 Oct 22];3:206. Available from: http://www.onlinejets.org/text.asp?2010/3/2/206/62105


Sir,

Plasmodium falciparum causes over one million deaths every year. The management of severe malaria includes prompt administration of appropriate parenteral antimalarial agents and early recognition and treatment of complications. The complications include metabolic acidosis, hypoglycemia, hyperlacticacidemia, severe anemia, seizures and raised intracranial pressure, renal failure, and pulmonary edema. [1]

Red cell exchange using a cell separator (therapeutic erythrocytapheresis) has been used successfully in combination with antimalarial treatment in a large number of acute severe cases of malaria. [2],[3],[4]

We present a case report of a male patient of 38 years, an irregular immigrant of Chinese nationality who had arrived in our country in a ship that sailed from Guinea Conakry 3 weeks before the hospital admission. He was referred to our hospital from a reception center for immigrants after 1 week of evolution of fever, with deterioration of his general state, abdominal pain, vomiting, jaundice, headache, and decreased level of consciousness. He had no medical antecedents of interest. In the emergency department he had repeated convulsions and required endotracheal intubation and connection to a mechanical ventilator. His laboratory results showed thrombocytopenia, renal failure, hyponatremia, and increased liver enzymes. With the epidemiological background of the patient, malaria was suspected and a thick blood film was taken and stained for detecting Plasmodium falciparum. As there was a parasite infestation rate of 21%, we proceeded urgently to automated erythrocytapheresis through a dialysis catheter, aiming for replacement of 70% of his hematocrit so that the rate of parasitism would be brought down to < 1%. The patient was also treated with intravenous infusions of quinine and doxycycline. The patient responded favorably. Within a few days he could be disconnected from the mechanical ventilator, and he was discharged to the ward a week later.

Isolated parasitemia above 10%, or a parasitemia above 5% associated with any additional World Health Organization - 2000 criteria of clinical severity, is indication for erythrocytapheresis. [2]

Erythrocytapheresis consists of removal of the red-cell fraction by apheresis. Plasma and leukocyte and platelet fractions are returned to the patient. [5] Current-generation automated cell-separator hardware and software allows prompt red cell exchange or erythrocytapheresis in a single continuous-flow isovolemic procedure and can achieve a dramatic reduction in parasitemia within 2 h. Erythrocytapheresis has significant advantages over exchange transfusion in terms of speed, efficiency, and maintenance of hemodynamic stability. It allows retention of plasma components such as clotting factors and may thus represent an important adjunctive therapy in severe malaria.

 
   References Top

1.Njuguna P, Newton C. Management of severe falciparum malaria. J Postgrad Med 2004;50:45-50.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Fernández-Fuertes LF, Tapia-Martín M, Angel-Moreno A, Pisos-Alamo E, Losada-Castillo MC, Díaz-Cremades JM, et al. Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients. Med Clin (Barc) 2008;131:298-301.  Back to cited text no. 2      
3.Deshpande A, Kalgutkar S, Udani S. Red cell exchange using cell separator (therapeutic erythrocytapheresis) in two children with acute severe malaria. J Assoc Physicians India 2003;51:925-6.  Back to cited text no. 3      
4.Macallan DC, Pocock M, Robinson GT, Parker-Williams J, Bevan DH. Red cell exchange, erythrocytapheresis, in the treatment of malaria with high parasitaemia in returning travellers. Trans R Soc Trop Med Hyg 2000;94:353-6.  Back to cited text no. 4      
5.Macallan DC, Pocock M, Bishop E, Bevan DH, Parker-Williams J, Harrison T, et al. Automated erythrocytapheresis in the treatment of severe falciparum malaria. J Infect 1999;39:233-6.  Back to cited text no. 5      

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Correspondence Address:
Luciano Santana-Cabrera
Intensive Care Unit, Universitary Hospital Insular in Gran Canaria, Las Palmas de Gran Canaria
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.62105

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