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Original ArticleOpen Access
Exchange Transfusion in Severe Falciparum Malaria
Gulprasutdilog S 
,
Clzongkolwatana V ,
Buranakitjaroen P ,
Jaroonvesama N
,
Clzongkolwatana V ,
Buranakitjaroen P ,
Jaroonvesama N Malaria associated with complications or a fatal outcome is caused by Plasmodium
falciparum. The mortality due to this disease is parallel to the degree of parasitemia. Successful
use of exchange blood transfusion as a therapeutic adjunct for this infection was reported. The
rationale for this form of therapy is based on (1) rapid reduction in parasite load by exchange
transfusion, (2) removal of toxic substances and (3) reducing microcirculatory sludging. We
describe here thirteen cases of severe falciparum malaria treated with infusion of quinine dihydrochloride
and exchange transfusion 2,320 - 8,000 ml of whole blood. We observed that the
greatest reduction in the average circulating infected red blood cells, from 20.7 per cent to 9.3
per cent, seemed to occur early in the first 2,000 ml of blood exchange and the parasitemia
often reduced to 5.1 per cent in patients who had 4,000 ml of blood exchange. In order to reduce
the initial parasitemia to 5 per cent by exchange transfusion, we suggest the volume of exchange
transfusion should be 2,000 ml for average parasitemia 10 per cent, 4,000 ml for parasitemia > 20
per cent and 2,000 - 4,000 ml for parasitemia 10 - 20 per cent.
Key word : Severe Falciparum Malaria - Exchange Transfusion
falciparum. The mortality due to this disease is parallel to the degree of parasitemia. Successful
use of exchange blood transfusion as a therapeutic adjunct for this infection was reported. The
rationale for this form of therapy is based on (1) rapid reduction in parasite load by exchange
transfusion, (2) removal of toxic substances and (3) reducing microcirculatory sludging. We
describe here thirteen cases of severe falciparum malaria treated with infusion of quinine dihydrochloride
and exchange transfusion 2,320 - 8,000 ml of whole blood. We observed that the
greatest reduction in the average circulating infected red blood cells, from 20.7 per cent to 9.3
per cent, seemed to occur early in the first 2,000 ml of blood exchange and the parasitemia
often reduced to 5.1 per cent in patients who had 4,000 ml of blood exchange. In order to reduce
the initial parasitemia to 5 per cent by exchange transfusion, we suggest the volume of exchange
transfusion should be 2,000 ml for average parasitemia 10 per cent, 4,000 ml for parasitemia > 20
per cent and 2,000 - 4,000 ml for parasitemia 10 - 20 per cent.
Key word : Severe Falciparum Malaria - Exchange Transfusion
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