Repeat exchange transfusion for treatment of severe babesiosis

Transfus Apher Sci. 2019 Oct;58(5):638-640. doi: 10.1016/j.transci.2019.07.010. Epub 2019 Sep 5.


We report a case of severe babesiosis presenting with 43% parasitemia in a 73-year-old splenectomized woman on etanercept for rheumatoid arthritis. She initially was treated aggressively with clindamycin and quinine and exchange transfusion. Despite a post-exchange drop in parasitemia to 7.6%, it rebounded to 11.4% on hospital day 5 accompanied by new onset high fevers and hypoxia. She improved after a second exchange transfusion and ultimately resolved her infection after 12 weeks of antibabesial antibiotics. Although exchange transfusion is commonly used in immunocompromised hosts, there is a dearth of information about repeat exchange transfusion, including the risk for and outcome of repeat exchange. We performed a literature search for other cases of repeat exchange transfusion for severe Babesia microti infection and compared our case with those in other published reports.

Keywords: Babesia microti infection; Babesiosis; Exchange transfusion; Immunocompromised.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Arthritis, Rheumatoid / therapy
  • Babesia microti*
  • Babesiosis / etiology
  • Babesiosis / therapy*
  • Clindamycin / administration & dosage*
  • Etanercept / administration & dosage
  • Etanercept / adverse effects
  • Exchange Transfusion, Whole Blood*
  • Female
  • Humans
  • Parasitemia / etiology
  • Parasitemia / therapy
  • Quinine / administration & dosage*
  • Splenectomy


  • Clindamycin
  • Quinine
  • Etanercept