Objective: This study aims to study the efficacy of exchange transfusion in complicated malaria with hyperparasitaemia.
Method: This is a retrospective case-control study conducted in a tertiary care referral hospital in northeastern India. A retrospective chart review was done, and 34 children with hyperparasitaemia were identified. Of these, 16 children received only antimalarial chemotherapy, and 18 received adjunct exchange blood transfusion (EBT). The data was analyzed for survival benefit as the main outcome measure.
Results: The subjects in each of the groups were comparable in terms of age, sex distribution, and mean haemoglobin at presentation. The patients treated with EBT were more ill than those who did not receive EBT; they met a greater number of WHO criteria for severe malaria (2.94 ± 1.16 vs. 1.81 ± 0.83; p=0.002) and had higher levels of parasitaemia (23.96 ± 17.55 vs. 16.14 ± 6.89; p=0.0007). The mean volume exchanged was 44.88 ± 20.49 ml/kg, against a target of 70 ml/kg due to the unavailability of fresh, compatible whole blood. There was no difference in mortality in the exchange transfusion group compared to the chemotherapy alone group (22.22% vs. 31.25%; p=0.83).
Conclusions: In resource-limited areas, lower volumes of fresh whole blood for exchange transfusion can reduce hyperparasitaemia to a significant degree, and this may give some mortality benefit in very sick cases. Artesunate, by virtue of its rapid action, is capable of reducing hyperparasitaemia and may question the very place of blood transfusion in complicated malaria. It may also be worthwhile to accumulate more data comparing EBT against artesunate instead of quinine.
Keywords: artesunate; children; exchange blood transfusion; hyperparasitaemia; malaria.
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