Albumin infusions could potentially save the lives of children with severe malaria.

In children with severe malaria, acidosis (excessive acidity of body fluids) is strongly linked to risk of death. Acidosis may result from loss of blood volume, suggesting that fluid infusion would benefit patients in the crucial early stages of disease. However, fluid infusion is not routinely used, because of fears of side-effects and the lack of a strong evidence base supporting its use.

Working at Kilifi District Hospital, Kenya, Kath Maitland and colleagues at the KEMRI–Wellcome Trust Research Programme have carried out several small-scale trials demonstrating the benefits of fluid infusion in severe malaria. In a recently published work, infusion with albumin – a colloidal blood protein that keeps fluid inside blood vessels – was compared with use of a synthetic equivalent, gelofusine.

While both treatments reversed acidosis, mortality was significantly lower with albumin – suggesting that it has protective benefits beyond those conferred by its colloidal nature.

Considering all the evidence, Dr Maitland suggests that many childhood deaths in hospitals from malaria could be prevented by use of albumin – but as albumin is relatively expensive, and fluid infusions are not routinely used for paediatric malaria in Africa, its benefits first need to be demonstrated in a much larger trial.

External links

• Akech S et al. Volume expansion with albumin compared to gelofusine in children with severe malaria: results of a controlled trial. PLoS Clinical Trials 2006;1(5):e21.