October 18, 1985

More Uses for Apheresis

Author Affiliations

Institute of Tropical Medicine
Red Cross Transfusion Center Antwerp, Belgium

JAMA. 1985;254(15):2064. doi:10.1001/jama.1985.03360150040016

To the Editor.—  We read with great interest the report of the American Medical Association Panel on Therapeutic Plasmapheresis1 and were surprised that loiasis with hypermicrofilaremia and overwhelming Plasmodium falciparum malaria were not included in the list of indications for apheresis.At least two reports2,3 give strong evidence for the efficiency of apheresis in the removal of Loa loa microfilaria. This well-tolerated procedure is particularly useful in avoiding severe toxic reactions—in some cases fatal—occurring in patients with a high microfilarial load being treated with diethylcarbamazine.Similarly, automated erythrocyte exchange transfusion has proved effective in rapidly reducing high P falciparum blood load. Erythrocytapheresis combined with transfusion of packed red blood cells using a flow cell separator and specific chemotherapy should be strongly advocated in cases of malaria with either cerebral, renal, pulmonary, or hemostatic complications and parasitemia in excess of 10%.4-9Because apheresis may have a useful, and