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Exchange Transfusion for Severe Malaria: Evidence Base and Literature Review.
MedLine Citation:
PMID:  23800940     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background. Exchange transfusion (ET) has biologic plausibility an adjunct to antimalarial drugs in treating severe malaria and has been used for decades despite limited evidence of its efficacy in improving survival. We examined the efficacy of ET as an adjunct treatment for severe malaria using US surveillance data and reviewed the literature to update recommendations. Methods. Patients with severe malaria reported to the US national malaria surveillance system from 1985-2010 were matched, and survival outcomes were compared between patients receiving and not receiving ET. The literature review used search terms 'severe malaria' and "exchange transfusion." Case reports and series, observational and case-control studies, and meta-analysis were included. Results. 101 patients receiving ET were matched to 314 patients not receiving ET. There was no statistically significant association between ET and survival outcome (odds ratio 0.84, 95% confidence interval 0.44-1.60). We found 87 articles, mostly case reports or series showing successful use of ET; likely reporting bias. There were 12 comparative studies, most retrospective cohort, underpowered with no significant differences in survival. A previously published meta-analysis of 8 comparative studies found no significant survival differences. Adverse events were rarely reported but included acute respiratory distress syndrome, ventricular fibrillation, and hypotension. Conclusions. Despite rapid parasite clearance times resulting from ET, there is no evidence for efficacy of ET as adjunctive therapy in severe malaria . Adjunct ET cannot be recommended. When rapidly acting antimalarials, specifically artemisinins, become more widely available, the biologic plausibility argument for ET will become less relevant.
Authors:
Kathrine R Tan; Ryan E Wiegand; Paul M Arguin
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-24
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  -     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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