Automated red blood cell exchange as an adjunctive treatment for severe Plasmodium falciparum malaria at the Vienna General Hospital in Austria: a retrospective cohort study.
Automated red blood cell exchange as an adjunctive treatment for severe Plasmodium falciparum malaria at the Vienna General Hospital in Austria: a retrospective cohort study.
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DOI：
10.1186/1475-2875-11-158
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发表时间：
2012-05-07
期刊：
影响因子：
3
通讯作者：
Worel N
中科院分区：
文献类型：
--
作者：
Auer-Hackenberg L;Staudinger T;Bojic A;Locker G;Leitner GC;Graninger W;Winkler S;Ramharter M;Worel N
尽管进行了适当的抗疟疾治疗，但严重恶性疟疾仍与相当高的死亡率有关。由于总生存率与寄生虫总生物量有关，因此血液交换输血被认为是一种快速减少外周寄生虫血症的潜在方法。然而，目前的证据表明，这种治疗方式可能不会改善结果。自动红细胞交换（也称为“红细胞穿刺”）一直被提倡作为一种替代方法，快速清除循环血液中的寄生虫，而不影响患者的体积和电解质状态。然而，只有来自病例报告和病例系列的有限证据可用于这种辅助治疗。这项回顾性队列研究描述了维也纳医科大学使用自动红细胞交换治疗严重疟疾的情况。报告了奥地利输入性疟疾病例的流行病学数据，并从电子医院记录中提取了在维也纳总医院/医科大学治疗疟疾患者的数据。2000年至2010年期间，维也纳医科大学有146名患者因疟疾住院，其中16人被列为严重疟疾病例。该队列中有11例患者可能有资格接受自动红细胞交换的辅助治疗。5例患者最终在入院后7小时（范围：3-19小时）内接受了该手术。根据主治医生的决定，6例患者没有接受这种辅助治疗。在所有病例中，该手术耐受性良好，寄生虫计数迅速减少，没有发生血流动力学并发症。1名患者在7天内死亡，而4名患者存活，没有任何后遗症。自动红细胞交换是一种安全有效的方法，可以快速清除外周寄生虫血症。然而，寄生虫生物量的快速减少是否最终会提高患者的生存率仍不清楚。需要随机对照试验来最终评价这种辅助治疗的价值。
Severe falciparum malaria is associated with considerable rates of mortality, despite the administration of appropriate anti-malarial treatment. Since overall survival is associated with total parasite biomass, blood exchange transfusion has been proposed as a potential method to rapidly reduce peripheral parasitaemia. However, current evidence suggests that this treatment modality may not improve outcome. Automated red blood cell exchange (also referred to as “erythrocytapheresis”) has been advocated as an alternative method to rapidly remove parasites from circulating blood without affecting patients’ volume and electrolyte status. However, only limited evidence from case reports and case series is available for this adjunctive treatment. This retrospective cohort study describes the use of automated red blood cell exchange for the treatment of severe malaria at the Medical University of Vienna. Epidemiologic data for imported malaria cases in Austria are reported and data of patients treated for malaria at the General Hospital/Medical University of Vienna were extracted from electronic hospital records. Between 2000 and 2010, 146 patients were hospitalized at the Medical University of Vienna due to malaria and 16 of those were classified as severe malaria cases. Eleven patients of this cohort were potentially eligible for an adjunctive treatment with automated red blood cell exchange. Five patients eventually underwent this procedure within a period of seven hours (range: 3–19 hours) after hospital admission. Six patients did not undergo this adjunctive treatment following the decision of the treating physician. The procedure was well tolerated in all cases and rapid reduction in parasite counts was achieved without occurrence of haemodynamic complications. One patient died within seven days, whereas four patients survived without any sequelae. Automated red blood cell exchange was a safe and efficient procedure to rapidly clear peripheral parasitaemia. Whether the fast reduction in parasite biomass may ultimately improve patient survival remains however unclear. Randomized controlled trials are needed to conclusively appreciate the value of this adjunctive treatment.
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影响因子：
168.9
作者：
Brandts, CH;Ndjave, M;Kremsner, PG
通讯作者：
Kremsner, PG
影响因子：
11.8
作者：
Mordmüller, B;Kremsner, PG
通讯作者：
Kremsner, PG
影响因子：
11.8
作者：
Ramharter, M;Oyakhirome, S;Kremsner, PG
通讯作者：
Kremsner, PG
影响因子：
2.7
作者：
Ramharter, M;Wernsdorfer, WH;Kremsner, PG
通讯作者：
Kremsner, PG
影响因子：
4
作者：
Burkhardt, Dominik;Wiesner, Jochen;Borrmann, Steffen
通讯作者：
Borrmann, Steffen