Transfusion-transmitted malaria and bacterial infections in a malaria endemic region

Background and Methods: Blood transfusion saves lives and improves health but the presence of transfusion transmissible infections can have untoward consequences. When undetected, these infections can cause significant morbidity and mortality to transfusion recipients. On the other hand, a high prevalence of transfusion-transmitted infections (TTI) leading to rejection of a large proportion of donated blood can result in blood shortages and subsequent increase in mortality. Malaria and bacterial infections are transfusion transmissible but there is limited data concerning these infections in sub-Saharan Africa. Although the burden of transfusion-transmitted malaria in malaria endemic countries are unknown, it is recommended that all donated blood is screened for malaria parasites and presumptive treatment be given to transfusion recipients. Bacterial contamination in sub-Saharan Africa has been reported to occur in between 8 - 17% of stored blood but the effect of contamination on transfusion recipients has not been determined. Syphilis is currently the only bacterial infection for which routine screening is recommended but screening is not being performed in many blood centres including Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana where this study took place. This study examined the effects of transfusion-transmitted malaria (TTM) and bacterial infections (including syphilis) on transfusion recipients in a malaria endemic area. Four malaria screening tests were compared to assess their usefulness in the context of African blood banks. Pregnant women, children and immune-compromised transfusion recipients from the Departments of Obstetrics and Gynaecology, Paediatrics, Medicine and Oncology in KATH were enrolled into the study. Results: Anti-malarial drugs were routinely prescribed with paediatric transfusions. Fifty patients were evaluated after receiving blood transfusions that were positive for P. falciparum by PCR and seven recipients developed PCR-detectable parasitaemia. In only one recipient (2%) was TTM confirmed. The prevalence of P. falciparum malaria in transfused blood was 4.7% (21/445) by microscopy, 13.7% (60/440) by rapid diagnostic test, 18% (78/436) by polymerase chain reaction and 22.2% (98/442) by enzyme immunoassay. Bacterial contamination was found in 11.5 %( 95% CI 7.0-16.0%) (23/200) of donated blood units but only half of the recipients were observed to developed adverse signs of transfusion related sepsis. The mean duration of storage of blood was 2 days. The prevalence of syphilis sero-positivity in donated blood was 8.0% (95% CI 4.3-11.7%). Seroconversion took place in an 8 year old girl, after receiving a syphilis sero-positive unit of blood. Conclusions: This thesis has shown that malaria parasites may be commonly detected in donor blood but TTM occurs infrequently in recipients living in malaria endemic areas. The high rate of bacterial contamination and its associated transfusion related sepsis poses a safety risk to transfusion recipients. Transfusion-transmitted syphilis remains a risk for transfusion recipients in blood centres with a high prevalence and short duration of storage of donor blood