Stowell et al listed indications for when to perform a red blood cell exchange in a patient with babesiosis.
Indications for blood exchange:
(1) level of parasitemia greater than 10% (high level parasitemia)
(2) high risk patient (see below)
(3) serious complications (see below)
High risk patient:
(1) > 50 years of age
(2) asplenia
(3) immunosuppression
Serious complications:
(1) acute respiratory failure
(2) severe hemolysis
(3) acute renal failure
(4) DIC (disseminated intravascular coagulation)
A patient undergoing red blood cell exchange to reduce parasite load should receive concurrent antimicrobial therapy. Regimens may include one of the following:
(1) clindamycin AND quinine
(2) atovaquone AND azithromycin
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