Red cell exchange transfusion(RCET) is a treatment option for severe falciparum malaria, which reduces the parasite load and toxemia. Pulmonary edema, metabolic changes, hyperkalemia, arrhythmia, hypocalcemia due to citrate toxicity, rebound hypoglycemia, hypothermia, anaphylactic reactions, hypotension or hypertension, thrombocytopenia, thrombo-embolism, coagulopathy, and necrotizing enterocolitis are the major acute phase RCET complications. In our case of severe falciparum malaria that was resistant to treatment; reduction in parasite load and sepsis was observed following RCET, but severe acute respiratory distress syndrome (ARDS) has developed.

Keywords: Severe falciparum malaria, red cell exchange transfusion, acute respiratory distress sendrome (ARDS)