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Presentation3 (1)

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Presentation3 (1)

  1. 1. Transfusion Associated Malaria Dr Prakash.I
  2. 2. Introduction  Special consideration  Rarity  Delay in diagnosis  Treatment  Serious complications  1st reported in 1911  In non-endemic countries - incidence is low  Canada: 1994 and 1999 -3  USA: 1990 and 1999 -14  UK since 1996 -2  Other European countries-2  US- <0.3 case/million transfused blood units
  3. 3.  Uniqueness - caused by injection of asexual forms (Trophozoite)  Trophozoite-induced malaria Vs natural infection pre- erythrocytic schizogony - absent short incubation period exo-erythrocytic schizogony - not seen relapses do not occur radical cure is possible
  4. 4. In Transfusion Associated Malaria  Relapsing illness: P. vivax and P. ovale  Asymptomatic parasitemia variable and depends on species  P. vivax and P. ovale rarely persist > 3 years  P. falciparum rarely > 1-2 years(3 mo)  P. malariae parasites for decades
  5. 5.  Donor-exclusion criteria's aim : balance between risk of malaria and excluding uninfected donors  Drawback in prevention:  screening techniques not satisfactory  Criteria for suitable test for screening: large-scale use design high sensitivity and specificity detect all 4 species of Plasmodium
  6. 6. Blood film microscopy  Traditional blood film microscopy – More manpower high technical skill limited sensitivity  Microscopic exam (thick blood film-4 ml): A single parasite equivalent to ∼10,000parasites in a 450-mL unit of blood
  7. 7. Antibody detection test Antibody detection: ELISA, immunofluorescence assay (IFA) Malaria antibody testing:  95% sensitive and 99% specific In endemic region: +ve predictive value is high
  8. 8.  Malaria antibody screening  do not indicate active infection  high discarding of collected blood units  Residents in malaria-endemic countries: have anti-malarial Ab serologic tests are unhelpful for screening donors  Donors from Endemic region: immunity to malaria→ low levels of parasites without clinical symptoms, undetectable levels of parasitaemia
  9. 9. Antigen detection test  Antigen detection by MAB (monoclonal antibody) technique : more sensitive practically feasible screening test  PCR and antigen detection tests - limited availability
  10. 10. Blood transfusion recipients  Nonimmune recipient - can become rapidly fatal  Young infants in malaria endemic regions:  nonimmune recipients  Clinical severity different:  Endemic Vs Non endemic
  11. 11. Blood products  As few as 15 parasites (one bite): can cause malaria.  Whole-blood and RBC concentrates: most common source.  Platelets, FFP, and leukocytes: may infrequently transmit malaria.
  12. 12. Prevention  Endemic countries: specific donor questioning considering  Seasonal variation  Geographical distribution  Antigen detection by monoclonal Ab as a routine screening procedure:  in endemic countries  Anti-malarials to recipients may help to prevent transmission  Prevention largely depends on careful questioning donors
  13. 13.  FDA recommends deferring residents Endemic areas : 3 years Had malaria/Chemo : 3 years (after they become asymp.) Non endemic : 1 year after return from malarious area  In EU Endemic area : 3 yrs Non-endemic areas donors: 4-12 months Some countries reject these donors(NED) for 3 years or permanently (if resided for >6 months in the endemic area)
  14. 14. Evidence based  Support for Recommendations: 97% and 99% of the reported malaria cases in U.S. and foreign civilians occur within 1 and 3 years, respectively, of having been in a malarious area  AABB: Uniform donor history questions
  15. 15.  Travelers may donate blood 6 months after returning from endemic areas if they have been free of symptoms and have not taken antimalarial drugs  Persons who have had malaria or who had been taking chemoprophylaxis shall be deferred from donating blood for 3 years after either becoming asymptomatic or stopping therapy or chemoprophylaxis  Immigrants or visitors from endemic areas may be accepted as donors 3 years after departure if they are asymptomatic in the interim  Donations for preparing plasma, plasma components, or derivatives devoid of intact red blood cells are exempted from these restrictions
  16. 16. Thank You

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