Babesiosis is a zoonotic disease transmitted by Ixodes ticks seen in the United States and parts of Europe. Because of the typically mild course of most infections, the disease is uncommonly seen in clinical practice. However, asplenic patients can develop a life-threatening infection. The first line of therapy for Babesia infections is antiparasitic medications; however, red blood cell (RBC) exchange transfusion has been described as an adjunct therapy. We describe a severe case of babesiosis in an asplenic patient and review the evidence, indications, and protocols for RBC exchange transfusion in this setting.
Powell VI, Grima K. Exchange transfusion for malaria and Babesia infection. Transfus Med Rev 2002;16:239-50.
Hatcher JC, Greenberg PD, Antique J, Jimenez-Lucho VE. Severe babesiosis in Long Island: Review of 34 cases and their complications. Clin Infect Dis 2001;32:1117-25.
Cahill KM, Benach JL, Reich LM, Bilmes E, Zins JH, Siegel FP, et al. Red cell exchange: Treatment of babesiosis in a splenectomized patient. Transfusion 1981;21:193-8.
Miller KD, Greenberg AE, Campbell CC. Treatment of severe malaria in the United States with a continuous infusion of quinidine gluconate and exchange transfusion. N Engl J Med 1989;321:65-70.
Tan KR, Wiegand RE, Arguin PM. Exchange transfusion for severe malaria: Evidence base and literature review. Clin Infect Dis 2013;57:923-8.
Schwartz J, Winters JL, Padmanabhan A, Balogun RA, Delaney M, Linenberger ML, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: The sixth special issue. J Clin Apher 2013;28:145-284.
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43:1089-134.
Spaete J, Patrozou E, Rich JD, Sweeney JD. Red cell exchange transfusion for babesiosis in Rhode Island. J Clin Apher 2009;24:97-105.
Jacoby GA, Hunt JV, Kosinski KS, Demirjian ZN, Huggins C, Etkind P, et al. Treatment of transfusion-transmitted babesiosis by exchange transfusion. N Engl J Med 1980;303:1098-100.
Vannier E, Krause PJ. Human babesiosis. N Engl J Med 2012;366:2397-407.