HYPERPARASITEMIA AND BLOOD-EXCHANGE TRANSFUSION FOR TREATMENT OF CHILDREN WITH FALCIPARUM-MALARIA

A substantial number of reports of cases and small investigations supp ort blood exchange transfusion as a therapy for hyperparasitemia in ca ses of Plasmodium falciparum malaria, although a prospective and rando mized study has never been undertaken, We report on 113 prospectively enrolled children in Lambarene, Gabon, who had more than 10% parasitiz ed erythrocytes and were treated with chemotherapy alone. All 86 patie nts with hyperparasitemia as the sole complication recovered uneventfu lly. Among the 27 patients who had additional complications, parasitem ia levels as high as 81% responded well to chemotherapy alone. Two pat ients with cerebral malaria, who also had other complications and henc e a poor prognosis, died. Hyperparasitemia itself might be important f or the development of a fatal event in malaria, but a recommendation t o perform a dangerous, expensive, and labor-intensive procedure such a s blood exchange transfusion for its treatment should be based on subs tantial clinical research, especially in areas where malaria is a majo r health problem.