Red cell exchange, erythrocytapheresis, in the treatment of malaria with high parasitaemia in returning travellers

In severe falciparum malaria with high parasitaemia, removal of parasitized erythrocytes is generally considered to be of value as adjunctive therapy in addition to standard chemotherapy. Such removal is commonly achieved by exchange transfusion but this procedure is time-consuming and may be associ ated with haemodynamic disturbance. Current-generation automated cell-separ ator hardware and software allows prompt red cell exchange, erythrocytapher esis, in a single continuous-flow isovolaemic procedure. We describe the ap plication of this procedure to 5 cases of severe falciparum malaria in trav ellers returning to the UK from the tropics. All patients also received qui nine and conventional supportive therapy. In all cases, dramatic reduction in parasitaemia was achieved within 2 h with subsequent complete clinical r ecovery. Erythrocytapheresis has significant advantages over exchange trans fusion in terms of speed, efficiency, haemodynamic stability and retention of plasma components such as clotting factors and may thus represent an imp rovement in adjunctive therapy for severe malaria.