Donor Red Blood Cell morphology storage lessions and extra-infectious post transfusion effect of malaria parasitised donor blood

CaHReF 2016, Yaoundé Conges hall, 23 – 26 August 2016 , PL170

Background:  To harmonise diverging recommendations of anti-malaria programs (no presumptive treatment) and of blood transfusion programs (deffere malaria-parasitised blood bags or treat patient after transfusion) in Cameroon, evidence on the clinical impact of transfusing malaria-parasitised blood is necessary. With knowledge from recent studies showing the incidence of transfusion transmitted malaria (TTM) to be lower (2%) than generally assumed, we posed the question of "Besides the risk of TTM, how more risky are plasmodium-parasitised blood bags than plasmodium-free blood bags stored in the same blood bank conditions?"

Objective: To point out non infectious, post transfusion clinical outcomes of transfusing malaria-parasitised blood through a known indicator- The levels of morphology erythrocyte storage lesions, that measures donor blood quality. 
  A prospective, descriptive cross sectional study was conducted in the Yaoundé Central Hospital (YCH) from April to May 2015. 46 bags of Whole blood were recruited. Triplicates of thin blood smears were made per blood bag and stained according to the May Grunwald Giemsa technique. In each slide, plasmodium density and RBC lesions were both evaluated.Proportions of RBC alterations were compared between different groups of parasitic density using Chi-square test. Numerical values were determined and compared using the U-test of Wilcoxon-Mann-Whitney. All statistical analysis was done using Microsoft Excel 2007 and Epi Info (version 3.5.3). Factors which showed P-value >0.05 were considered as insignificant.

84.8% of blood bags had malaria parasites ranging from 2000 -57000 parasites/µl. 78.2% had RBC morphology lesions consisting of schistocytes (49.4% ) and echynocytes (47.8%). However, there was no significant difference in the levels of RBC morphology lesions in different groups of malaria parasite density (schistocytosis p1= 0.694 : echynocytosis p2= 0.955). There was equally no relation between grades of RBC storage lesions and plasmodium density (schistocytosis r1= 0.1566: echynocytosis r2= -0.1679).

The quality, and probably the clinical impact of malaria-parasitised donor blood do not differ from that of plasmodium-free donor blood. Given the high prevalence of parasitised blood bags in our context, it is cost effective to transfuse such blood bags and safe to rapidly test patient and treat any detected plasmodfium after transfusion.

Plasmodium, Donor blood, Erythrocyte morphology lesions, Clinical impact