The American Society for Apheresis (ASFA) has reported criteria for red blood cell exchange transfusion for a patient with severe babesiosis. Similar criteria are used by the Infectious Diseases Society of America (IDSA).
Patient selection: babesiosis
Indications for red blood cell exchange transfusion - one of the following:
(1) parasitemia > 10% (high grade)
(2) severe hemolytic anemia - one or more of the following
(2a) hematocrit < 20%
(2b) serum indirect bilirubin > 1.0 mg/dL
(2c) serum LDH > 900 U/L)
(3) pulmonary findings - one or both of the following:
(3a) any need for supplemental oxygen
(3b) severe pulmonary compromise)
(4) renal compromise (serum creatinine > 1.2 mg/dL)
(5) hepatic compromise - one or both of the following
(5a) serum total bilirubin > 5 mg/dL
(5b) INR >= 1.5)
(6) disseminated intravascular coagulation
