|
Overview :
Wilkinson et al identified certain patients with severe
falciparum malaria who may benefit from exchange transfusion in addition to
chemotherapy. The authors are from Northwick Park Hospital and the Hospital for
Tropical Diseases in England.
|
Parasitemia |
Other |
Rationale |
|
> 30% |
|
mortality with
chemotherapy alone is high |
|
> 10% |
clinical
complications present |
high mortality
rate |
|
> 10% |
pregnant |
|
|
> 10% |
late stage
parasites (schizonts) present in smear |
poor prognosis;
risk of sharp increase in parasite burden |
|
> 10% |
age > 60
years |
less able to
endure stress of complications |
where:
• Clinical
complications include cerebral malaria, renal failure, blackwater fever,
jaundice, pulmonary edema, hemoglobin < 6 g/dL (treated as organ failures in
the implementation).
• If the
argument that age > 60 is an indication based on the decreased ability to
endure the stress, then I wonder if anyone with significant comorbid disease
should also be considered. In practice, most of these people would develop a
clinical complication.
• For the
criteria about schizonts, I am uncertain if this would apply in a person with
mixed falciparum-vivax malaria.
|