Transfusion-Transmitted Malaria: A Systematic Review and Meta-analysis

Abstract

Background Malaria transmission through blood transfusion is an accidental but preventable cause of malaria infection and is increasingly becoming a matter of concern for blood transfusion services. This systematic review was conducted to provide a summary of evidence about the prevalence of Plasmodium infection in asymptomatic blood donors and the effectiveness of screening methods used based on the available literature. Methods PRISMA guidelines were followed. Scopus, PubMed, Science Direct, and EMBASE were searched from 1982 to October 10, 2017. All peer-reviewed original research articles describing the prevalence of malaria parasitemia in blood donors with different diagnostic methods were included. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. Incoherence and heterogeneity between studies were quantified by I2 index and Cochran’s Q test. Publication and population bias was assessed with funnel plots and Egger’s regression asymmetry test. All statistical analyses were performed using Stata (version 2.7.2). Results Seventy-one studies from 21 countries, 5 continents, were included in the present systematic review. The median prevalence of malaria parasitemia among 984 975 asymptomatic healthy blood donors was 10.54%, 5.36%, and 0.38% by microscopy, molecular methods (polymerase chain reaction), and rapid diagnostic tests, respectively. The most commonly detected Plasmodium species was P. falciparum. Conclusions This systematic review demonstrates that compared with other transfusion-linked infections, that is, HIV, HCV, and HBV, transfusion-transmitted malaria is one of the most significant transfusion-associated infections especially in Sub-Saharan Africa. Future work must aim to understand the clinical significance of transfusion-transmitted malaria in malaria-endemic settings.

Prevalence and trends of transfusion transmissible infections among blood donors in the State of Qatar, 2013–2017

“…These variations are also observed between the World Health Organization (WHO) regions. As African and Pacific regions are the highest in HBV prevalence, Eastern Mediterranean region is the highest for HCV prevalence, Sub-Saharan Africa is the highest for malaria, and scattered foci in southwestern Japan, Colombia and intertropical Africa are endemic for HTLV-1 [ 6 – 8 ].…”

Malaria parasitemia among blood donors in Uganda

“…The results are consistent with our current understanding of malaria throughout Africa and also in Uganda. In a meta‐analysis, malaria prevalence among healthy blood donors was 21% by microscopy and 36% by molecular methods . In a study in Ghana, Plasmodium genome prevalence was 50% by nucleic acid testing .…”

“…Transfusion of Plasmodium ‐infected RBCs can result in transfusion‐transmitted malaria (TTM). A recent meta‐analysis reported that the global prevalence of malaria in healthy blood donors as determined by microscopy is 10.5% . Despite the burden of disease, routine screening for malaria is uncommon practice, whereby only seven countries in Africa report blood donor screening for malaria using either a peripheral smear or antigen diagnostic test .…”

“…Despite the burden of disease, routine screening for malaria is uncommon practice, whereby only seven countries in Africa report blood donor screening for malaria using either a peripheral smear or antigen diagnostic test . This highlights a need for more research to understand the extent of TTM in endemic countries, particularly sub‐Saharan Africa where the majority of malaria infections occur …”

Inactivation of Plasmodium falciparum in whole blood using the amustaline and glutathione pathogen reduction technology

“…10 In contrast, in many endemic countries, especially in Sub-Saharan Africa, deferral of blood donors based on exposure to malaria parasite is not practical because of the high incidence. Malaria deferrals would lead to high rates of donor exclusion (>30%) 11 and blood shortages. Furthermore, screening for malaria parasites is not routinely performed.…”