Haematological parameters and clinical course of patients with severe malaria: Is there a role for Exchange Blood Transfusion in low middle income setting?

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Muhammad Shariq Shaikh, Omar Mahmud, Ahmed Raheem, Hamzah Jehanzeb, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6227746/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Severe malaria can manifest as a life-threating constellation of symptoms including acutely dysregulated haematologic and circulatory parameters. A strong association has been identified between high levels of parasitaemia and increased morbidity in patients suffering from severe malaria 1 . Exchange blood transfusion (EBT) is an adjunct therapy that involves replacing patient blood to clear infected cells and toxic metabolites 2,3 . Its biologically plausible effects are thought to include reduced parasite load, optimized hemodynamics, and improved oxygen-carrying capacity 2 . However, the evidence basis for its use remains mixed 4 . This short report describes the impact of EBTs in malaria with high parasitemia on patients’ haematological status in an LMIC setting. Full Text We retrospectively reviewed all cases of malaria admitted to the Aga Khan University Hospital (AKUH - a large tertiary care hospital in Karachi, Pakistan) between 2007 and 2015. The period was chosen as EBT has not been regularly performed thereafter and the last recorded instance with complete data obtained in our dataset was from 2015. Patients who presented with high parasitemia (>10%) and received EBT were included. Diagnosis was confirmed in all cases via microscopic identification of any stage of the plasmodial life cycle on peripheral blood smear obtained at the time of collection of blood for complete blood counts (CBCs). Demographic and clinical data, malarial species, and pre- and post-transfusion CBC parameters were extracted. Categorical variables were reported as frequencies or percentages. For continuous data, normality was assessed using the Shapiro-Wilks test. Normally distributed data were analyzed using the paired-sample t-test and non-normally distributed data using the wilcoxon signed-rank test. All data were analysed using the Statistical Package for the Social Sciences (IBM SPSS) version 21. P-values < 0.05 were considered significant. 30 patients (15 males and 15 females) were included. Consistent with regional trends, 16 patients had Vivax infections (age (median [IQR] = 41 [27.5-56.6]) while 10 were cases of P. falciparum (45 [32-64]) and 4 had mixed infections with both strains. This may have been due to the strain's proclivity for causing severe infection with high parasitaemia. Mean length of stay was 7.87 days (standard deviation: 12.79, range: 2-73) and 27 patients remained alive at the time of follow-up. Changes in haematologic status following EBT are summarized in Table. 1. Table 1 : Changes in hematological parameters in infected patients post transfusion All Patients (n=30) Haematological Parameters Pre-Transfusion Post-Transfusion p value Hb 10.38 ± 1.91 11.11 ± 2.74 0.003 Hct 33.98 ± 6.76 29.68 ± 6.73 < 0.001 RBC 4 ± 0.92 3.79 ± 0.67 0.008 MCV 83.79 ± 8.88 83.52 ± 7.44 0.491 MCH 27.47 ± 3.33 27.01 ± 4.13 0.21 MCHC 32.75 +1.34 32.86 ± 1.04 0.352 WBC 7.25 +4.57 10.01 ± 25.08 0.297 Neutrophils 69.93 ± 15.2 56.69 ± 15.16 < 0.001 Lymphocytes 21.7+ 13.07 30.36 12.87 < 0.001 Eosinophils 1.14 ± 1.31 1.63 ± 1.36 0.038 Monocytes 6.74 ± 4.64 11.18 ± 11.17 < 0.001 Basophils 0.33 ± 0.29 0.45 ± 0.33 0.008 Platelets 63.36 ± 71.14 120.26 ±109.24 < 0.001 P.vivax (n=16) Hb 10.2[11.8-8.9] 11.9[13.8-10] 0.004 Hct 33.3[39.35-30.6] 29.9[33.75-25.25] <0.001 RBC 3.98[4.8-3.48] 3.72[4.16-3.4] 0.011 MCV 85[89.1-77.8] 84.6[87.9-79.3] 0.635 MCH 27.7[28.9-25.8] 27.95[28.8-25.8] 0.654 MCHC 32.5[33.2-32] 32.6[33.3-32] 0.23 WBC 5.7[7.9-4.3] 5.85[8.5-4.9] 0.287 Neutrophils 72[80.9-63.7] 59[67.8-44.8] <0.001 Lymphocytes 21.3[27-13] 27.9[39.9-18.1] <0.001 Eosinophils 0.95[1.8-0.35] 1.15[2.2-0.7] 0.82 Monocytes 5.8[9.6-3] 9.5[12.3-6.2] 0.024 Basophils 0.2[0.35-0.1] 0.3[0.6-0.2] 0.146 Platelets 40[81-25] 69[124-45] 0.002 P.falciparum (n=10) Hb 9.9[10.9-9.3] 10.4[13.2-7.8] 0.692 Hct 31.75[38.9-25.5] 30.15[32.7-26.3] 0.043 RBC 4.14[4.64-2.76] 3.62[4.07-3.23] 0.676 MCV 86.35[90.2-81.3] 87.55[89.5-82.05] 0.222 MCH 29.05[29.8-26.4] 28.4[29.5-26.25] 0.187 MCHC 33.2[34.1-32.3] 33[33.3-32.6] 0.946 WBC 7.3[13.4-4.7] 6.35[10.45-5.2] 0.905 Neutrophils 74.05[86.1-66.2] 58.75[70.2-48.25] 0.001 Lymphocytes 17.5[24.3-8] 29.9[37.75-22.8] 0.015 Eosinophils 0.3[1.2-0.1] 1[1.9-0.6] 0.023 Monocytes 6.95[9.4-2.7] 9[12.9-7.2] 0.002 Basophils 0.2[0.6-0.1] 0.4[0.6-0.3] 0.248 Platelets 47[61-33] 72[167-44] 0.006 Mixed Infection (n=4) Hb 10.5[11.9-8.9] 11[12.1-10.8] 0.186 Hct 32.4[36.1-31.2] 29.4[35-25.8] 0.019 RBC 3.95[4.32-3.55] 3.65[4.23-3.33] 0.205 MCV 85.25[88.05-81.25] 84.5[89-77.6] 0.747 MCH 28.4[29.3-27.2] 28.3[29.4-26.6] 0.954 MCHC 33.2[33.9-32.45] 33.1[33.6-32.9] 0.766 WBC 6.8[9.4-5.7] 7.1[9-4.9] 0.956 Neutrophils 69.9[77.9-49] 55.4[62.9-48.3] 0.001 Lymphocytes 25[35.3-13.3] 29.9[42.3-24.6] 0.01 Eosinophils 1[1.6-0.4] 1.6[2.8-0.8] 0.037 Monocytes 6.4[9.9-2.3] 9.9[13.7-8.3] 0.01 Basophils 0.2[0.3-0.1] 0.5[0.6-0.4] 0.026 Platelets 54[115-35] 124[211-48] 0.017 Hb: Haemoglobin, Hct: Haematocrit, RBC: red blood cells, MCV: mean corpuscular volume, MCH: mean corpuscular haemoglobin, MCHC: mean corpuscular haemoglobin concentration, WBC: white blood cells There was significantly increased haemoglobin, but decreased haematocrit and RBC counts in the overall sample, with similar changes in the Vivax group. In the Falciparum subgroup, these changes were not seen besides decreased haematocrit. These results may indicate that the transfusions did not produce clear improvements in the malaria-induced anemia. A previous retrospective study also found no improvement in hemoglobin after transfusion in falciparum patients 5 However, this may not imply that EBT is inefficacious. It has been suggested that reductions in hematocrit reverse the pathologic circulatory changes of malaria, as elevated hematocrit can contribute to increased systemic vascular resistance and subsequent peripheral hypoperfusion and end-organ damage. 6 Moreover, EBT removes of circulating parasites, toxic metabolites, and inflammatory mediators. For example, hemozoin, which is produced by the germ's metabolism, is known to promote the development of a proinflammatory milieu through the activation of innate immunity and the release of interleukin 1-beta. 7 Thus, it is plausible that the effects of EBT on CBC parameters could help to reduce the complications of severe malaria by these mechanisms. Exchange transfusion reduced neutrophil counts across all subgroups. The role of neutrophils in malaria has been postulated to be a dual one; although they form one of the immune system’s first responses to malarial infection, they also contribute to the pathogenesis of the disease. In the setting of malaria infection, neutrophils release neutrophil extracellular traps (NETs), produce reactive oxygen species, and release toxic granules. In fact, neutrophil activity is positively correlated with the severity of malaria infection 8 . However, whether the effect of EBT on neutrophil counts affects the course of disease remains unclear. Thrombocytopenia is a diagnostic feature of malaria, with the degree of thrombocytopenia correlating with the degree of parasitemia and prognosis. 9 Our results showed improved platelet counts across all groups in contrast to an older retrospective study which found no improvement in platelet counts. 10 In terms of survival, exchange transfusion showed some promise, with all but 3 of the included patients surviving. Of the 3 patients who did not survive, 2 were infected with the more malignant falciparum strain, with the remaining patient being one of the older patients in the sample at 75 years of age. Overall, the prognosis for most patients infected with the much more common Vivax strain was good. Currently, the CDC does not recommend the use of EBT for malaria. 4 Moreover, a previous review found no survival advantage in patients who received EBT. 3 However, the authors noted that their analysis was underpowered, and, despite weak evidence, clinicians have continued to use and report experience with EBT in extremely sick patients. One important fact to consider regarding the evidence on the efficacy of EBT is that it is typically reserved patients with a poor clinical course portending death or severe morbidity despite management. Therefore, poor outcomes in these patients are, at least in part, due to an already severe disease course that is also typically refractory to other effective therapies. In conclusion, our study provides some data regarding the hematological parameters and clinical course of patients with severe malaria who received EBT. However, our results are based on uncontrolled pre-post comparisons in a small cohort, and are additive to the existing literature. Unfortunately, our dataset does not include patients with high parasitemia who did not receive EBT, nor does it comprehensively cover patients with parasitemia <10% who did receive EBT. The absence of these groups limits our ability to perform a direct comparison. Physicians may consider these data, previous studies, and their own clinical experience when judging the potential utility of EBT in cases where standard therapies have proved to be inadequate. The role of EBT as a useful intervention in low-resource settings may be clarified by future prospective studies. Declarations Ethics approval and consent to participate: The AKUH institutional ethics review committee exempted this study from the need to obtain participant consent due to the use of anonymized data extracted retrospectively. Consent for publication: Not Applicable Availability of data and materials: The datasets used and analysed during the current study are available from the corresponding author on request. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable. Authors' contributions: MSS, AR, and MAB designed and planned the study. AR, OM, and HJ contributed to data collection and writing of the initial draft of the manuscript. All authors read and approved the final manuscript Acknowledgements: The authors are grateful to staff who helped with retrieval in relation to archived medical records. References Malaria Article, https://www.statpearls.com/articlelibrary/viewarticle/24662/ (accessed 13 July 2023). Dongare HC, Khatib KI. Exchange Transfusion in Severe Falciparum Malaria. J Clin Diagn Res 2016; 10: OD05. Tan KR, Wiegand RE, Arguin PM. Exchange Transfusion for Severe Malaria: Evidence Base and Literature Review. Clinical Infectious Diseases 2013; 57: 923–928. CDC - Malaria - Exchange Transfusion, https://www.cdc.gov/malaria/new_info/2013/exchange_transfusion.html (accessed 19 July 2023). Lin J, Huang X, Qin G, et al. Manual exchange transfusion for severe imported falciparum malaria: a retrospective study. Malar J ; 17. Epub ahead of print 16 January 2018. DOI: 10.1186/S12936-018-2174-Z. Kingston HWF, Ghose A, Rungpradubvong V, et al. Cell-Free Hemoglobin Is Associated With Increased Vascular Resistance and Reduced Peripheral Perfusion in Severe Malaria. J Infect Dis 2020; 221: 127–137. Olivier M, Van Den Ham K, Shio MT, et al. Malarial Pigment Hemozoin and the Innate Inflammatory Response. Front Immunol ; 5. Epub ahead of print 2014. DOI: 10.3389/FIMMU.2014.00025. Kho S, Minigo G, Andries B, et al. Circulating Neutrophil Extracellular Traps and Neutrophil Activation Are Increased in Proportion to Disease Severity in Human Malaria. J Infect Dis 2019; 219: 1994. Tanwar GS, Khatri PC, Chahar CK, et al. Thrombocytopenia in childhood malaria with special reference to P. vivax monoinfection: A study from Bikaner (Northwestern India). Platelets 2012; 23: 211–216. Lin J, Huang X, Qin G, et al. Manual exchange transfusion for severe imported falciparum malaria: a retrospective study. Malar J ; 17. Epub ahead of print 16 January 2018. DOI: 10.1186/S12936-018-2174-Z. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6227746","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":429916243,"identity":"6746b1c3-c91e-498f-a8ae-75a82786bf2f","order_by":0,"name":"Muhammad Shariq Shaikh","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Shariq","lastName":"Shaikh","suffix":""},{"id":429916244,"identity":"4ac0d097-84b7-4233-9acc-dfc20c68bd2d","order_by":1,"name":"Omar Mahmud","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Omar","middleName":"","lastName":"Mahmud","suffix":""},{"id":429916245,"identity":"86f2f877-5514-4c1a-9754-2a2a7e017b44","order_by":2,"name":"Ahmed Raheem","email":"","orcid":"","institution":"The Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Raheem","suffix":""},{"id":429916247,"identity":"6a145b8a-09f2-4508-b2dc-eb8c5d3901c9","order_by":3,"name":"Hamzah Jehanzeb","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hamzah","middleName":"","lastName":"Jehanzeb","suffix":""},{"id":429916248,"identity":"04ee69b5-7478-4839-a7c7-6b0eff13e7ae","order_by":4,"name":"Afsheen Raza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIie3OsWqDUBSA4XMRbhaD6y3aPsMBIRFSyKt4EeJyH6CDgxCwS2LWPEbWbAHhZvEB3FoRnIQ6iUMrtZm6aOzW4f5wOJzhgwOgUv3fngB/Vg3aZGLfCDn+mWj6FLJ8veY1BLhezrayeA5WPJwl79C+DBMrdT0GEvl5J31bSJ+H+gbJLh0mDNwLA/rpYiYWpqAJD0EAzKMRYuTbFjpc49tHYzpdT4wKyFc3QphHGYmQnDKdmiTqCROgzcMxUlKHx8hP6WbxsI99O2IlJpYce8wvsrrpH7smJWub1ePB8PK8CobJLff3Qfu53AEqlUqlutM3iixMPHyWXTIAAAAASUVORK5CYII=","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":true,"prefix":"","firstName":"Afsheen","middleName":"","lastName":"Raza","suffix":""},{"id":429916250,"identity":"084eba7a-c169-46a6-8857-132280184038","order_by":5,"name":"Mohammad Asim Beg","email":"","orcid":"","institution":"The Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Asim","lastName":"Beg","suffix":""}],"badges":[],"createdAt":"2025-03-14 15:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6227746/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6227746/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79204566,"identity":"01aa8a60-fff1-4d2d-b3e3-52e6013d7f6e","added_by":"auto","created_at":"2025-03-25 15:23:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":612313,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6227746/v1/0a4ac901-35da-4617-a4e8-391ec24b2b8d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHaematological parameters and clinical course of patients with severe malaria: Is there a role for Exchange Blood Transfusion in low middle income setting?\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"\u003cp\u003eWe retrospectively reviewed all cases of malaria admitted to the Aga Khan University Hospital (AKUH - a large tertiary care hospital in Karachi, Pakistan) between 2007 and 2015. The period was chosen as EBT has not been regularly performed thereafter and the last recorded instance with complete data obtained in our dataset was from 2015. Patients who presented with high parasitemia (\u0026gt;10%) and received EBT were included. Diagnosis was confirmed in all cases via microscopic identification of any stage of the plasmodial life cycle on peripheral blood smear obtained at the time of collection of blood for complete blood counts (CBCs). Demographic and clinical data, malarial species, and pre- and post-transfusion CBC parameters were extracted. Categorical variables were reported as frequencies or percentages. For continuous data, normality was assessed using the Shapiro-Wilks test. Normally distributed data were analyzed using the paired-sample t-test and non-normally distributed data using the wilcoxon signed-rank test. All data were analysed using the Statistical Package for the Social Sciences (IBM SPSS) version 21. P-values \u0026lt; 0.05 were considered significant. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e30 patients (15 males and 15 females) were included. Consistent with regional trends, 16 patients had \u003cem\u003eVivax\u0026nbsp;\u003c/em\u003einfections (age (median [IQR] = 41 [27.5-56.6]) while 10 were cases of \u003cem\u003eP. falciparum\u003c/em\u003e (45 [32-64]) and 4 had mixed infections with both strains. This may have been due to the strain\u0026apos;s proclivity for causing severe infection with high parasitaemia. Mean length of stay was 7.87 days (standard deviation: 12.79, range: 2-73) and 27 patients remained alive at the time of follow-up. Changes in haematologic status following EBT are summarized in \u003cstrong\u003eTable. 1.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Changes in hematological parameters in infected patients post transfusion\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"611\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll Patients (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaematological Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e10.38 \u0026plusmn; 1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e11.11 \u0026plusmn; 2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e33.98 \u0026plusmn; 6.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e29.68 \u0026plusmn; 6.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e4 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e3.79 \u0026plusmn; 0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e83.79 \u0026plusmn; 8.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e83.52 \u0026plusmn; 7.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e27.47 \u0026plusmn; 3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e27.01 \u0026plusmn; 4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e32.75 +1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e32.86 \u0026plusmn; 1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e7.25 +4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e10.01 \u0026plusmn; 25.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eNeutrophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e69.93 \u0026plusmn; 15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e56.69 \u0026plusmn; 15.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eLymphocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e21.7+ 13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e30.36 12.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eEosinophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e1.14 \u0026plusmn; 1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e1.63 \u0026plusmn; 1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMonocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e6.74 \u0026plusmn; 4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e11.18 \u0026plusmn; 11.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eBasophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e0.33 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e0.45 \u0026plusmn; 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e63.36 \u0026plusmn; 71.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e120.26 \u0026plusmn;109.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP.vivax\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(n=16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e10.2[11.8-8.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e11.9[13.8-10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e33.3[39.35-30.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e29.9[33.75-25.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e3.98[4.8-3.48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e3.72[4.16-3.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e85[89.1-77.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e84.6[87.9-79.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e27.7[28.9-25.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e27.95[28.8-25.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e32.5[33.2-32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e32.6[33.3-32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e5.7[7.9-4.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e5.85[8.5-4.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eNeutrophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e72[80.9-63.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e59[67.8-44.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eLymphocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e21.3[27-13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e27.9[39.9-18.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eEosinophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e0.95[1.8-0.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e1.15[2.2-0.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMonocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e5.8[9.6-3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e9.5[12.3-6.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eBasophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e0.2[0.35-0.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e0.3[0.6-0.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e40[81-25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e69[124-45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP.falciparum (n=10)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e9.9[10.9-9.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e10.4[13.2-7.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e31.75[38.9-25.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e30.15[32.7-26.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e4.14[4.64-2.76]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e3.62[4.07-3.23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e86.35[90.2-81.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e87.55[89.5-82.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e29.05[29.8-26.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e28.4[29.5-26.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e33.2[34.1-32.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e33[33.3-32.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e7.3[13.4-4.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e6.35[10.45-5.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eNeutrophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e74.05[86.1-66.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e58.75[70.2-48.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eLymphocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e17.5[24.3-8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e29.9[37.75-22.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eEosinophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e0.3[1.2-0.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e1[1.9-0.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMonocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e6.95[9.4-2.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e9[12.9-7.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eBasophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e0.2[0.6-0.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e0.4[0.6-0.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e47[61-33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e72[167-44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixed Infection (n=4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e10.5[11.9-8.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e11[12.1-10.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eHct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e32.4[36.1-31.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e29.4[35-25.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e3.95[4.32-3.55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e3.65[4.23-3.33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e85.25[88.05-81.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e84.5[89-77.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e28.4[29.3-27.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e28.3[29.4-26.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMCHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e33.2[33.9-32.45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e33.1[33.6-32.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e6.8[9.4-5.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e7.1[9-4.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eNeutrophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e69.9[77.9-49]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e55.4[62.9-48.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eLymphocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e25[35.3-13.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e29.9[42.3-24.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eEosinophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e1[1.6-0.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e1.6[2.8-0.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eMonocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e6.4[9.9-2.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e9.9[13.7-8.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003eBasophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e0.2[0.3-0.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e0.5[0.6-0.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.4615%;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.1866%;\"\u003e\n \u003cp\u003e54[115-35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.7136%;\"\u003e\n \u003cp\u003e124[211-48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6383%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eHb: Haemoglobin, Hct: Haematocrit, RBC: red blood cells, MCV: mean corpuscular volume, MCH: mean corpuscular haemoglobin, MCHC: mean corpuscular haemoglobin concentration, WBC: white blood cells\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere was significantly increased haemoglobin, but decreased haematocrit and RBC counts in the overall sample, with similar changes in the \u003cem\u003eVivax\u003c/em\u003e group. In the \u003cem\u003eFalciparum\u003c/em\u003e subgroup, these changes were not seen besides decreased haematocrit. These results may indicate that the transfusions did not produce clear improvements in the malaria-induced anemia. A previous retrospective study also found no improvement in hemoglobin after transfusion in \u003cem\u003efalciparum\u003c/em\u003e patients \u003csup\u003e5\u003c/sup\u003e However, this may not imply that EBT is inefficacious. It has been suggested that reductions in hematocrit reverse the pathologic circulatory changes of malaria, as elevated hematocrit can contribute to increased systemic vascular resistance and subsequent peripheral hypoperfusion and end-organ damage.\u003csup\u003e6\u003c/sup\u003e Moreover, EBT removes of circulating parasites, toxic metabolites, and inflammatory mediators. For example, hemozoin, which is produced by the germ\u0026apos;s metabolism, is known to promote the development of a proinflammatory milieu through the activation of innate immunity and the release of interleukin 1-beta.\u003csup\u003e7\u003c/sup\u003e Thus, it is plausible that the effects of EBT on CBC parameters could help to reduce the complications of severe malaria by these mechanisms. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExchange transfusion reduced neutrophil counts across all subgroups. The role of neutrophils in malaria has been postulated to be a dual one; although they form one of the immune system\u0026rsquo;s first responses to malarial infection, they also contribute to the pathogenesis of the disease.\u003csup\u003e\u0026nbsp;\u003c/sup\u003eIn the setting of malaria infection, neutrophils release neutrophil extracellular traps (NETs), produce reactive oxygen species, and release toxic granules. In fact, neutrophil activity is positively correlated with the severity of malaria infection\u0026nbsp;\u003csup\u003e8\u003c/sup\u003e. However, whether the effect of EBT on neutrophil counts affects the course of disease remains unclear.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThrombocytopenia is a diagnostic feature of malaria, with the degree of thrombocytopenia correlating with the degree of parasitemia and prognosis.\u003csup\u003e9\u003c/sup\u003e Our results showed improved platelet counts across all groups in contrast to an older retrospective study which found no improvement in platelet counts.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn terms of survival, exchange transfusion showed some promise, with all but 3 of the included patients surviving. Of the 3 patients who did not survive, 2 were infected with the more malignant \u003cem\u003efalciparum\u003c/em\u003e strain, with the remaining patient being one of the older patients in the sample at 75 years of age. Overall, the prognosis for most patients infected with the much more common \u003cem\u003eVivax\u003c/em\u003e strain was good.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, the CDC does not recommend the use of EBT for malaria.\u003csup\u003e4\u003c/sup\u003e Moreover, a previous review found no survival advantage in patients who received EBT.\u003csup\u003e3\u003c/sup\u003e However, the authors noted that their analysis was underpowered, and, despite weak evidence, clinicians have continued to use and report experience with EBT in extremely sick patients. One important fact to consider regarding the evidence on the efficacy of EBT is that it is typically reserved patients with a poor clinical course portending death or severe morbidity despite management. Therefore, poor outcomes in these patients are, at least in part, due to an already severe disease course that is also typically refractory to other effective therapies.\u003c/p\u003e\n\u003cp\u003eIn conclusion, our study provides some data regarding the hematological parameters and clinical course of patients with severe malaria who received EBT. However, our results are based on uncontrolled pre-post comparisons in a small cohort, and are additive to the existing literature. Unfortunately, our dataset does not include patients with high parasitemia who did not receive EBT, nor does it comprehensively cover patients with parasitemia \u0026lt;10% who did receive EBT. The absence of these groups limits our ability to perform a direct comparison. Physicians may consider these data, previous studies, and their own clinical experience when judging the potential utility of EBT in cases where standard therapies have proved to be inadequate. The role of EBT as a useful intervention in low-resource settings may be clarified by future prospective studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe AKUH institutional ethics review committee exempted this study from the need to obtain participant consent due to the use of anonymized data extracted retrospectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;for publication:\u0026nbsp;\u003c/strong\u003eNot\u0026nbsp;Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and analysed during the current study are available from the corresponding author on request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eMSS, AR, and MAB designed and planned the study. AR, OM, and HJ contributed to data collection and writing of the initial draft of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors are grateful to staff who helped with retrieval in relation to archived medical records.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMalaria Article, https://www.statpearls.com/articlelibrary/viewarticle/24662/ (accessed 13 July 2023).\u003c/li\u003e\n\u003cli\u003eDongare HC, Khatib KI. Exchange Transfusion in Severe Falciparum Malaria. \u003cem\u003eJ Clin Diagn Res\u003c/em\u003e 2016; 10: OD05.\u003c/li\u003e\n\u003cli\u003eTan KR, Wiegand RE, Arguin PM. Exchange Transfusion for Severe Malaria: Evidence Base and Literature Review. \u003cem\u003eClinical Infectious Diseases\u003c/em\u003e 2013; 57: 923\u0026ndash;928.\u003c/li\u003e\n\u003cli\u003eCDC - Malaria - Exchange Transfusion, https://www.cdc.gov/malaria/new_info/2013/exchange_transfusion.html (accessed 19 July 2023).\u003c/li\u003e\n\u003cli\u003eLin J, Huang X, Qin G, et al. Manual exchange transfusion for severe imported falciparum malaria: a retrospective study. \u003cem\u003eMalar J\u003c/em\u003e; 17. Epub ahead of print 16 January 2018. DOI: 10.1186/S12936-018-2174-Z.\u003c/li\u003e\n\u003cli\u003eKingston HWF, Ghose A, Rungpradubvong V, et al. Cell-Free Hemoglobin Is Associated With Increased Vascular Resistance and Reduced Peripheral Perfusion in Severe Malaria. \u003cem\u003eJ Infect Dis\u003c/em\u003e 2020; 221: 127\u0026ndash;137.\u003c/li\u003e\n\u003cli\u003eOlivier M, Van Den Ham K, Shio MT, et al. Malarial Pigment Hemozoin and the Innate Inflammatory Response. \u003cem\u003eFront Immunol\u003c/em\u003e; 5. Epub ahead of print 2014. DOI: 10.3389/FIMMU.2014.00025.\u003c/li\u003e\n\u003cli\u003eKho S, Minigo G, Andries B, et al. Circulating Neutrophil Extracellular Traps and Neutrophil Activation Are Increased in Proportion to Disease Severity in Human Malaria. \u003cem\u003eJ Infect Dis\u003c/em\u003e 2019; 219: 1994.\u003c/li\u003e\n\u003cli\u003eTanwar GS, Khatri PC, Chahar CK, et al. Thrombocytopenia in childhood malaria with special reference to P. vivax monoinfection: A study from Bikaner (Northwestern India). \u003cem\u003ePlatelets\u003c/em\u003e 2012; 23: 211\u0026ndash;216.\u003c/li\u003e\n\u003cli\u003eLin J, Huang X, Qin G, et al. Manual exchange transfusion for severe imported falciparum malaria: a retrospective study. \u003cem\u003eMalar J\u003c/em\u003e; 17. Epub ahead of print 16 January 2018. DOI: 10.1186/S12936-018-2174-Z.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6227746/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6227746/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSevere malaria can manifest as a life-threating constellation of symptoms including acutely dysregulated haematologic and circulatory parameters. A strong association has been identified between high levels of parasitaemia and increased morbidity in patients suffering from severe malaria\u003csup\u003e1\u003c/sup\u003e. Exchange blood transfusion (EBT) is an adjunct therapy that involves replacing patient blood to clear infected cells and toxic metabolites\u003csup\u003e2,3\u003c/sup\u003e. Its biologically plausible effects are thought to include reduced parasite load, optimized hemodynamics, and improved oxygen-carrying capacity\u003csup\u003e2\u003c/sup\u003e. However, the evidence basis for its use remains mixed\u003csup\u003e4\u003c/sup\u003e. This short report describes the impact of EBTs in malaria with high parasitemia on patients’ haematological status in an LMIC setting.\u003c/p\u003e","manuscriptTitle":"Haematological parameters and clinical course of patients with severe malaria: Is there a role for Exchange Blood Transfusion in low middle income setting?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-18 04:42:01","doi":"10.21203/rs.3.rs-6227746/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f6cac30-b940-404a-8782-2c691ab28180","owner":[],"postedDate":"March 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-25T15:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-18 04:42:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6227746","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6227746","identity":"rs-6227746","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}