Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA; Biconcavity Inc., Retired USPHS Officer at Centers for Disease Control and Prevention,1106 Spring Mill Dr. SW, Lilburn, GA 30047, USA.
Case Western Reserve University, University Hospitals Cleveland Medical Center, Department of Pathology, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Transfus Apher Sci. 2020 Jun;59(3):102733. doi: 10.1016/j.transci.2020.102733. Epub 2020 Jan 27.
Using indicators of disease severity, clinicians can predict which Plasmodium falciparum (Pf) malaria patients being treated with artesunate or quinine are likely to die despite these drugs. Effective "rescue adjuncts" are needed when drugs alone are inadequate. "Therapeutically-rational exchange" (T-REX) of special malaria-resistant red blood cells (RBCs) has been proposed to optimize adjunctive exchange transfusion.
Studies were reviewed that (1) quantified how group-O status and "sickle-trait" (HbAS) and "C-trait" (HbAC) hemoglobins affect Pf mortality, risk of thrombosis, or birth outcomes for women with pregnancy associated malaria (PAM), (2) reported prevalences of "dual-gene" malaria-resistant RBCs, or (3) reflected the level of exchange-transfusion and malaria-related expertise in Benin and Nigeria.
Data show that the malaria- and thrombosis-resistance of RBCs depend on specific genes and the patient's clinical status and medical history. In malaria-endemic Benin and Nigeria, prevalences of "dual-gene" malaria-resistant group-O HbAS and group-O HbAC RBCs are substantial, and both malaria- and exchange-related expertise are outstanding.
T-REX of "dual-gene" malaria-resistant RBCs is feasible in Benin and Nigeria and warrants evaluation as a rescue adjunct for 3 subsets of Pf-malaria patients. For therapeutic use, group-O HbAS RBCs are likely to be more effective than non-O HbAS RBCs for Pf-infected patients who (1) have a history of thrombosis or (2) are taking birth-control hormones while group-O HbAC RBCs may substantially improve birth outcomes for women with PAM. Studies suggest it is prudent to assume - until proven otherwise - that T-REX of "dual-gene" malaria-resistant RBCs can improve ("personalize") rescue of these patient subsets.
临床医生可以使用疾病严重程度指标来预测接受青蒿琥酯或奎宁治疗的恶性疟原虫（Pf）疟疾患者尽管接受了这些药物仍可能死亡。当药物单独使用不足时，需要有效的“辅助治疗药物”。已经提出了特殊抗疟红细胞（RBC）的“治疗合理交换”（T-REX），以优化辅助性输血交换。
综述了（1）量化 O 型血状态以及“镰状细胞特征”（HbAS）和“C 特征”（HbAC）血红蛋白如何影响妊娠相关疟疾（PAM）妇女的 Pf 死亡率、血栓形成风险或分娩结局，（2）报告“双重基因”抗疟 RBC 的流行率，或（3）反映贝宁和尼日利亚的输血交换和疟疾相关专业知识水平。
数据表明 RBC 的疟疾和血栓形成抗性取决于特定基因以及患者的临床状况和病史。在疟疾流行的贝宁和尼日利亚，“双重基因”抗疟 O 型血 HbAS 和 O 型血 HbAC RBC 的流行率很高，并且疟疾和交换相关的专业知识都很出色。
在贝宁和尼日利亚，“双重基因”抗疟 RBC 的 T-REX 是可行的，并且值得作为 3 种 Pf 疟疾患者亚组的辅助治疗药物进行评估。对于治疗用途，对于（1）有血栓形成史或（2）正在服用避孕药激素的 Pf 感染患者，O 型血 HbAS RBC 可能比非 O 型血 HbAS RBC 更有效，而 O 型血 HbAC RBC 可能会大大改善 PAM 妇女的分娩结局。研究表明，在没有其他证据证明的情况下，明智的做法是假设 T-REX 的“双重基因”抗疟 RBC 可以改善（“个性化”）这些患者亚组的抢救效果。
