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Current evidence and future of automated erythrocyte exchange in the treatment of severe malaria

Automatisierter Erythrozytenaustausch als Therapieoption bei komplizierter Malaria: Evidenzlage und Ausblick

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Summary

Despite the administration of antimalarial treatment, severe malaria still has a high mortality rate. Since overall survival is associated with total parasite biomass, whole blood exchange (e.g. blood exchange transfusions) has been proposed as a potential method to rapidly reduce peripheral parasitaemia. Automated red blood cell exchange has been advocated as a physical method to remove parasites. Compared to exchange transfusion, automated red blood exchange may avoid the risk of volume alterations and haemodynamic distress. Since 1984, there have been 37 published cases in which automated red blood cell exchange was used as an adjunctive treatment in severe malaria caused by Plasmodium falciparum. This short review summarizes current evidence and discusses problems, challenges and goals for future studies and research in order to assess the clinical benefit of automated erythrocyte exchange in severe malaria cases.

Zusammenfassung

Die komplizierte Malaria weist trotz adäquater medikamentöser Behandlung immer noch eine hohe Mortalität auf. Da das Überleben unter anderem mit der Parasitämie vergesellschaftet ist, wurde schon früh der Nutzen eines Blutaustausches (Austauschtransfusion) bei Patienten mit komplizierter Malaria und hoher Parasitenzahl diskutiert. Der automatisierte und selektive Austausch von befallenen Erythrozyten ist ein potentieller Ansatz, um die periphere Parasitenzahl zu reduzieren, ohne dadurch hämodynamische Probleme und Störungen des Volumen- und Elektrolythaushalts zu verursachen. Seit 1984 wurden 37 Fälle von komplizierter Malaria durch Plasmodium falciparum beschrieben, die unter anderem mit dieser Technik erfolgreich behandelt wurden. Diese Arbeit diskutiert die derzeitige Evidenzlage des automatisierten Erythrozytenaustausches und kommentiert Probleme, Herausforderungen und Ziele zur weiteren Entwicklung dieser Therapieform.

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Conflict of interest

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1190, Vienna, Austria

    Lorenz Auer-Hackenberg, Stefan Winkler, Wolfgang Graninger &  Michael Ramharter MD

  2. Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany

    Michael Ramharter MD

  3. Department of Bloodgroup Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria

    Nina Worel

Authors
  1. Lorenz Auer-Hackenberg
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  2. Stefan Winkler
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  3. Wolfgang Graninger
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  4. Nina Worel
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  5. Michael Ramharter MD
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Correspondence to Michael Ramharter MD.

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Auer-Hackenberg, L., Winkler, S., Graninger, W. et al. Current evidence and future of automated erythrocyte exchange in the treatment of severe malaria. Wien Klin Wochenschr 124 (Suppl 3), 23–26 (2012). https://doi.org/10.1007/s00508-012-0238-6

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  • DOI: https://doi.org/10.1007/s00508-012-0238-6

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