Babesiosis is a tick-borne disease primarily transmitted by the intraerythrocytic protozoa Babesia microti in the U.S., which causes malaria-like symptoms and severe hemolytic anemia that range from being asymptomatic to causing death. With rising incidence of babesiosis and nearly 2000 confirmed babesiosis cases annually in the U.S., clinically validated treatments for babesiosis are needed. RBC exchange transfusions typically remove and re-transfuse roughly 10 units of RBCs and have been used to reduce the parasitemia of patients with severe babesiosis for over 40 years based on case studies. To more rigorously test this treatment, researchers retrospectively analyzed data from 629 adults hospitalized (median age, 71 years; 71% male) with severe babesiosis (parasitemia >10% or parasitemia 5-10% with Hb < 7 g/dL or acute organ injury) from 2010 to 2014 from 82 hospitals in the Northeast U.S. Patients were divided into two cohorts—209 of whom received exchange transfusions (median of 10 units of RBCs) and 420 hospitalized patients with babesiosis who did not. Approximately 3.6% of patients who received exchange transfusions died or were re-admitted within 30 days compared to 9.8% of patients who did not receive exchange transfusions (odds ratio, 0.22; 95% C.I., 0.09 to 0.51) even though patients in the exchange cohort were more likely to have higher parasitemia loads and were more likely to be immunocompromised. Further research on exchange transfusions for severe babesiosis is needed.
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