Background: Transfusion-associated malaria is a potentially serious complication that continues to pose risks in blood bank settings. There is a need for effective malaria screening of blood donations to improve on the current exclusion policies of potentially infected carriers on the basis of clinical and travel history. We evaluated the potential usefulness of ELISA screening for malaria antibody and P. falciparum antigen among Saudi blood donors. Materials and Methods: A total of 1756 donors were studied, 1100 from the malaria endemic Southern Region and 656 donors from the known malaria-free Riyadh area. Results: The overall antibody prevalence for the antibody was 7.6%, in comparison to only 0.17% for the antigen. In the endemic region, the antibody positivity rate of 9.1% was almost double the rate in the non-endemic area (4.8%). There was no difference in the antigen prevalence rates; 0.18% in endemic and 0.15% in non-endemic areas. Conclusions: In malaria endemic countries like Saudi Arabia, excluding antibody-positive donations would result in too much wastage of blood units. However, antigen malaria testing appears to offer a potential utility, as only few donations would be rejected.

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