Exchange Transfusion for Severe Malaria

Background: Exchange transfusion (ET) is a controversial ancillary treatment of severe falciparum malaria. Patients and Methods: We conducted a retrospective analysis of severe malaria treated in our institution. Nine cases of ET were identified between 1991 and 1998 and compared to 12 controls with similar parasitemia. Results: Groups were similar at admission except for an increased age in the ET group (p < 0.02). All patients received iv quinine. Outcome was similar in both groups (two deaths in the ET group, three in the control group). However, in patients with parasitemia > 30%, the death rate was significantly lower in ET patients than in controls (0/4 vs 3/3, p < 0.029). Conclusion: Despite definitive data from controlled trials, we suggest that ET should be considered in severe malaria cases with very high parasitemia and severity criteria or worsening clinical condition despite adequate chemotherapy.