Phillips P, Nantel S, Benny W B
Division of Infectious Diseases, Vancouver General Hospital, British Columbia, Canada.
Rev Infect Dis. 1990 Nov-Dec;12(6):1100-8. doi: 10.1093/clinids/12.6.1100.
Malaria associated with complications or a fatal outcome is almost always caused by Plasmodium falciparum. The mortality due to this disease parallels the degree of parasitemia. Successful use of exchange blood transfusion as a therapeutic adjunct for this infection was first reported in 1974, although the efficacy of this procedure has not been established by randomized, controlled trials. The rationale for this form of therapy is based on: (1) rapid reduction in the parasite load by direct removal; (2) decreased risk of severe intravascular hemolysis and its consequences (disseminated intravascular coagulation and renal dysfunction); (3) improved rheology with transfused blood and reduced microcirculatory sludging; and (4) improved oxygen-carrying capacity with transfused erythrocytes. We describe a case of severe falciparum malaria and review the literature describing the use of exchange transfusion for treatment of this infection.
伴有并发症或致命结局的疟疾几乎总是由恶性疟原虫引起的。该疾病导致的死亡率与寄生虫血症程度平行。1974年首次报道成功使用换血疗法作为这种感染的辅助治疗方法，尽管该程序的疗效尚未通过随机对照试验得到证实。这种治疗形式的基本原理基于：（1）通过直接去除迅速降低寄生虫负荷；（2）降低严重血管内溶血及其后果（弥散性血管内凝血和肾功能障碍）的风险；（3）通过输血改善血液流变学并减少微循环淤滞；（4）通过输注红细胞提高携氧能力。我们描述了一例严重恶性疟疾病例，并回顾了描述使用换血疗法治疗这种感染的文献。
