A two month Saudi infant developed Plasmodium vivax malaria after receiving one unit of blood transfusion in the nursery of a Saudi Arabian hospital. While conducting the epidemiological investigation two more cases of similar medical history (two neonatal cases of Plasmodium falciparum malaria after blood transfusion) were found. An epidemiological investigation was conducted to identify factors leading to these cases of transfusion malaria.
Methodology
Records of all blood administered to the three cases were reviewed. All donors of these blood units were interviewed about recent exposure to malarious areas. Mothers of the index babies were interviewed about history of travel to malarious areas, symptoms and signs of malaria, and antenatal history. The screening procedures at the blood bank were reviewed, and other transfusion malaria reports from the same city were reviewed.
Results
Regarding the first case: the index infant received blood transfusion of one unit of packed cells from a donor who was from a malarious area in Sudan and had no history of travel during the last 6 months. Regarding the second case: four of the 38 donors were from malarious areas in their countries and all had history of travel to their home areas within 6 months prior to their donation; two of them were from malarious villages in Yemen, one was from a malarious village in Sudan and one was from a malarious village in southwestern Saudi Arabia. Regarding the third case: three of 64 donors were from malarious areas in their countries and all had history of travel to their home areas within 6 months prior to their blood donation; one was from a malarious village in Kenya, one was from a malarious village in Sudan and one was from a malarious village in Yemen. The review of malaria cases at Riyadh health directorate showed that 292 cases had been reported during 1999, four of them were transfusion malaria cases. The rate of blood transfusion malaria for 1999 was 8.95 per 100,000 transfusions.
Conclusion
The high rate of transfusion malaria has resulted from incomplete screening of donors for travel to malarious areas and less sensitive routine tests. We recommend that blood banks in this city exclude donors who had traveled to malarious areas during the preceding 6 months, or if prophylaxis had been taken during the past 3 years. We also suggest the use of a more sensitive (e.g. immunochromatographic) test to detect low parasitemias.