[Treatment of fulminant XXXX with erythrapheresis].

@entity1 @entity2002 @entity417 @entity648 @entity5642 @entity9231 @entity4807 @entity10041 @entity3964 @entity2798
Ten days after his return from Cameroon, a twenty-six year old Frenchman, serving on @entity2798 , presented with fulminant @entity9231 : shock, altered consciousness, @entity417 , threatening @entity5642 (platelets less than 150 X 10(-6).l-1; prothrombin time and Stuart factor less than 50%; @entity2002 less than 1.5 g.l-1). In spite of @entity4807 therapy, parasitaemia increased from 4 to 35% within 24 h. Using an Haemonetics V50, the exchange of one and a half red blood cell masses was carried out with 17 red blood cell packs. @entity10041 was used to prevent the hypocalcaemia induced by the anticoagulant solution. The @entity1 's platelets and plasma were completely reinjected. The result was very satisfactory. This kind of exchange, well tolerated clinically and biologically, would seem better than the classical exchange transfusion. When 10% of the red blood cells are infected by @entity3964 , it is necessary to exchange from one and a half to two blood masses. Lesser exchanges are always associated with important relapses and @entity4807 therapy must be carried on during and after the exchange. Restricting this exchange only to red blood cells enabled the @entity1 to benefit from his own coagulation factors, antibodies and platelets, and consequently to reduce the number of blood donors involved. However, metabolites (especially @entity648 and circulating immune complexes) were not eliminated. Partial plasmapheresis may be associated with erythropheresis using @entity1 albumin as plasma substitute. This technique needs to be assessed, in order to optimize immediate efficiency and post-transfusion infectious risk.
