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Exchange blood transfusion in severe falciparum malaria: retrospective evaluation of 61 patients treated with, compared to 63 patients treated without, exchange transfusion

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The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive ‘toxic’ factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician’s subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4–4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non-systematic approach.
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Keywords: Plasmodium falciparum; exchange blood transfusion; malaria; treatment

Document Type: Original Article

Affiliations: 1: Institute for Tropical Medicine, University of Tübingen, Germany, 2: Hospital München-Schwabing, Munich, Germany, 3: Ospedale Generale, Bolzano, Italy, 4: Missionsärztliche Klinik, Würzburg, Germany, 5: Institute of Tropical Medicine, Antwerp, Belgium, 6: University Hospital Antwerp, Edegem, Belgium, 7: Department of Internal Medicine, University Hospital Zurich, Switzerland, 8: Kaiser Franz Josef-Spital, Vienna, Austria, 9: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, 10: Stadtspital Triemli, Zurich, Switzerland, 11: Department of Infectious Diseases and Tropical Medine, University of Munich, 12: University Hospital Benjamin Franklin, Berlin, Germany, 13: University Hospital for Neurology, Innsbruck, Austria, 14: Tropenklinik Paul-Lechler-Krankenhaus, Tübingen, Germany, 15: Institute for Medical Biometry, Tübingen, Germany

Publication date: 1997-08-01

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