Clinical Sequelae Of Transfusion Of Donor Blood Exposed To Selected Transfusion-Transmissible Parasites And Molecular Confirmation Of Transfusion-Transmissible Malaria

Abstract

Transfusion-transmitted parasite infections (TTPI) are potentially underreported. However, still regarded as a public health concern, as they might constitute a major threat, particularly in immunocompromised patients. This study was performed at the Nsawam Government Hospital, Ghana and aimed to identify the presence of Plasmodium falciparum (Pf), Babesia spp., Leishmania spp., and Toxoplasma gondii in donor blood and investigate their potential association with acute transfusion responses (ATR). Transfusion-transmissible malaria (TTM) and the associated Pf chloroquine resistance transporter (Pfcrt), Pf multi-drug resistance (Pfmdr1), Pf dihydropteroate-synthetase (Pfdhps), Pf dihydrofolate-reductase (Pfdhfr) and Kelch 13 mutant genes were further assessed. Remnants of transfused blood were screened for Pf using malaria rapid diagnostic test and microscopy. Enzyme-linked immunosorbent assay was used for the others. Recipients of blood infected with Pf were followed up for 35 days. Selective whole genome amplification was used to determine TTM and gene polymorphisms. Approx. 20% (113/571) of recipients were exposed. The prevalence were: Pf (12.1%), Babesia spp. (1.1%), Leishmania spp. (2.8%), and T. gondii (3.9%). ATR was experienced by recipients of blood exposed (10.6%, 12/113) and unexposed to parasites (5.8%, 19/327) however, there was no significant difference (p = 0.112) between the two groups. Genomic analysis found mutant haplotypes: Pfdhps (14.4%), Pfmdr1 (14.4%), Pfdhfr (12.9%), Kelch 13 (9.4%) and Pfcrt (5.7%). Pfcrt mutant gene, CVINT was identified for the first time in Ghana. Drug-resistant markers were found to be ~20% with a TTM incidence of 7%. Donor blood should be screened for malaria and other haemoparasites and further research to quantify risk of TTM.