Can Blood Transfusion Cause Malarial Fever?
Yes, blood transfusion can transmit malaria and cause malarial fever, though this risk is now very low in non-endemic countries due to donor screening protocols. 1, 2
Mechanism and Risk of Transmission
Malaria parasites (particularly Plasmodium falciparum) can survive in refrigerated packed red blood cells for up to 18 days and in platelets throughout their storage period, making transfusion-transmitted malaria (TTM) biologically plausible. 1
Asymptomatic parasitemic donors pose the greatest transmission risk because they pass routine symptom-based screening that occurs during blood donation. 1, 3
The median prevalence of malaria parasitemia among asymptomatic blood donors in endemic areas is 10.54% by microscopy and 5.36% by molecular methods, demonstrating substantial reservoir of infection. 3
In non-endemic regions like Europe and North America, approximately 20 TTM cases occurred in the past 20 years, with the vast majority of implicated donors being former residents of hyperendemic areas in Africa. 2
Clinical Presentation of Transfusion-Transmitted Malaria
TTM typically manifests 10 days to 4 weeks after transfusion with fever, chills, headache, body aches, and malaise—symptoms identical to mosquito-transmitted malaria. 4
One documented case showed a dramatic presentation 32 hours post-transfusion with fever and multiorgan failure in a thalassemia patient, where parasites replicated rapidly in the transfused normal red blood cells (14.4% parasitemia in donor cells versus 0.029% in patient's cells). 5
The infection can be severe or fatal, particularly in immunosuppressed recipients such as those undergoing chemotherapy or organ transplantation. 1
Current Screening and Prevention Strategies
Organs should be rejected if the donor's death is secondary to malaria; for other organs from donors with chronic infection, close follow-up with molecular testing is recommended to promptly initiate therapy. 1
The questionnaire-based strategy asking about travel to or residence in malaria-endemic areas within the preceding 3 years is the primary screening method in non-endemic countries. 1, 2
No practical screening method currently exists to detect all asymptomatic infected donors, as standard microscopy misses low-level parasitemia and molecular testing is not routinely performed. 1, 6
Leukoreduction of blood products does not eliminate transmission risk, as documented cases have occurred despite this intervention. 1
Critical Actions When TTM is Suspected
Suspected transfusion-associated malaria should be reported immediately to the blood product supplier and public health authorities to facilitate tracking and quarantining of co-components and notification of other recipients. 1
If a recent blood donor develops symptoms of malaria, the blood bank must be notified immediately so donated blood can be quarantined or recalled. 1
Thick and thin blood smears with Giemsa stain remain the gold standard for diagnosis, though molecular methods (PCR) are 10-100 times more sensitive for detecting low-level parasitemia. 4, 7
Treatment Considerations
Treatment follows standard malaria protocols: intravenous artesunate for severe disease or oral artemisinin-based combination therapy for uncomplicated cases, regardless of transmission route. 4, 7
The first dose of antimalarial medication should be administered when blood smears are obtained if clinical suspicion is high, without waiting for confirmation. 7
Common Pitfalls to Avoid
Do not assume fever within 6 hours of transfusion is simply a febrile non-hemolytic reaction in patients from or who have traveled to endemic areas—consider TTM and obtain thick/thin smears. 5
Do not rely solely on travel history screening, as former residents of endemic areas may harbor chronic low-level parasitemia for extended periods. 2
Malaria cannot currently be detected by nucleic acid technology used for other transfusion-transmitted infections like HIV and hepatitis C. 1