Abstract
BackgroundPolicies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. To prevent spreading drug resistance due to over-use of malaria drugs, recent malaria treatment guidelines recommend prompt parasitological confirmation before treatment is started. In contrast, blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking. Our study documented how these conflicting policies relating to malaria transmission through blood transfusion impact on clinical practice in a teaching hospital in West Africa.Methods/Principal FindingsWe randomly selected and reviewed case notes of 151 patients within 24 hours of their receiving a blood transfusion. Transfusion practices including the confirmation of diagnosis and anti-malarial treatment given were compared across three departments; Obstetrics and Gynaecology (O&G), Paediatrics and Medicine. Overall, 66 (44%) of patients received malaria treatment within 24 hrs of their blood transfusion; of which only 2 (3%) received anti-malarials based on a laboratory confirmation of malaria. Paediatric patients (87%) received the most anti-malarials and only 7% and 24% of recipients in medicine and O&G respectively received anti malarials. In 51 patients (78%), the anti-malarials were prescribed at the same time as the blood transfusion and anti-malarials prescriptions exceeded the number of patients with a presumptive diagnosis of malaria.ConclusionsIt is common practice in paediatrics to prescribe anti-malarials routinely with blood transfusions. This contravenes the malaria treatment guidelines of laboratory confirmation before treatment but is in accordance with the less-well evidenced blood safety guidelines. There is an urgent need for more evidence about the clinical impact of transfusion transmitted malaria to enable malaria and blood transfusion programmes to harmonize their policies and give clear guidance to clinicians who prescribe blood transfusions in malaria-endemic areas
Highlights
Malaria is one of the most important parasitic diseases in the world
There is an urgent need for more evidence about the clinical impact of transfusion transmitted malaria to enable malaria and blood transfusion programmes to harmonize their policies and give clear guidance to clinicians who prescribe blood transfusions in malaria-endemic areas
The majority of patients (64.9%) were female, because of the inclusion of the obstetric department, and the median age of all patients was 22.0 years (IQR: 4.0–36.0) (Table 1). 25 patients (16.6%) had received a blood transfusion during a previous admission and the highest rates of previous transfusions were in the department of medicine (45.5%). 66% of transfusion recipients from medicine, 65% from obstetrics and 15% from paediatrics had received a transfusion during the current admission prior to enrolment in the study
Summary
Malaria is one of the most important parasitic diseases in the world. In 2009, there were approximately 225 million malaria cases in the world with 781,000 deaths [1]. An area of malaria control which has been neglected in endemic countries is malaria transmission through blood transfusion. Blood transfusion has been recognised as one of the transmission routes for malaria since 1911 [2] the prevalence of transfusion transmitted malaria (TTM) in sub-Saharan Africa remains unknown. In endemic countries a substantial proportion of the population have asymptomatic parasitaemia. This makes it difficult to be sure whether malaria occurring after blood transfusion was acquired from the transfusion or not. Policies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. Blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
