Wilkinson et al identified certain patients with severe falciparum malaria who may benefit from exchange transfusion in addition to chemotherapy. The authors are from Northwick Park Hospital and the Hospital for Tropical Diseases in England.
Parasitemia
Other
Rationale
> 30%
mortality with chemotherapy alone is high
> 10%
clinical complications present
high mortality rate
> 10%
pregnant
> 10%
late stage parasites (schizonts) present in smear
poor prognosis; risk of sharp increase in parasite burden
> 10%
age > 60 years
less able to endure stress of complications
where:
• Clinical complications include cerebral malaria, renal failure, blackwater fever, jaundice, pulmonary edema, hemoglobin < 6 g/dL (treated as organ failures in the implementation).
• If the argument that age > 60 is an indication based on the decreased ability to endure the stress, then I wonder if anyone with significant comorbid disease should also be considered. In practice, most of these people would develop a clinical complication.
• For the criteria about schizonts, I am uncertain if this would apply in a person with mixed falciparum-vivax malaria.
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