EXCHANGE BLOOD-TRANSFUSION IN SEVERE FALCIPARUM-MALARIA - RETROSPECTIVE EVALUATION OF 61 PATIENTS TREATED WITH, COMPARED TO 63 PATIENTS TREATED WITHOUT, EXCHANGE-TRANSFUSION

The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presump tive 'toxic' factors, and improvement of the rheological quality of th e blood. We evaluated the records of 61 patients treated with ET to de scribe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of br pat ients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exch ange transfusion is applied according to the clinician's subjective im pression rather than strict guidelines. Logistic regression analysis a djusting for the differences in clinical parameters between patients t reated with or without ET did not identify treatment as a prognostic i ndicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4-4.9) Excharge transfusion did not significantly improve the unfavo urable prognosis in cases of severe falciparum malaria. However, failu re to reach statistical significance may be due to the retrospective d esign of the study and therefore non-systematic approach.