Exchange Transfusion in Malaria with High Parasitaemia: A Case Series from a Pakistani Tertiary Care Centre

Case Series

Abstract

Introduction

High levels of parasitaemia are associated with a poor prognosis in severe malaria. Exchange blood transfusion (EBT) is an adjunct therapy used in these patients. The goal of this series was to review cases of malaria with high parasitaemia where patients received EBT.

Methods

We conducted a retrospective review of case-records from 2007-2015 at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. Patients diagnosed with malaria via a positive peripheral blood smear who received EBT due to high levels of parasitaemia (>10%) were included. The changes in clinical haematology parameters after EBT were analyzed.

Results

30 patients were included. The mean age was 44.80 years (Standard deviation: 18.34). 16 patients had Plasmodium vivax infection, 10 had Plasmodium falciparum infection, and 4 had mixed infection. Mean length of stay was 7.87 days (standard deviation: 12.79). 27 patients survived through follow-up. Following EBT, haemoglobin and platelets were seen to improve by 7% and 90% respectively, although large patient to patient variation was observed.

Conclusion

EBT may benefit patients with haematological derangements such as anaemia and thrombocytopenia during severe malaria. Prospective studies should better evaluate EBT as it is an accessible intervention in low-resource areas of malarial