This document describes the case of a preterm infant born to a 32-year-old mother who developed malaria after receiving multiple blood transfusions in the NICU. The infant was born via emergency C-section at 32 weeks gestation. After an initial period of respiratory support, the infant developed fever, apnea, and declining vital signs. Blood tests showed anemia and elevated inflammatory markers. A blood smear revealed malaria parasites, and the infant was treated with antimalarial medications. The blood bank was notified, as the malaria was believed to have come from one of the five blood transfusions the infant received. Both donors tested negatively for malaria at the time of donation but could not be reached for retesting. The

1. Transfusion Associated
Malaria
Dr Prakash. I
NICU

2. Maternal history
 B/O ABC, 2nd of triplets
 32 yrs. old, P0+0,Booked,PH national
 HIV, HBsAg-Neg, VDRL-Non reactive, Rubella-
Immune
 Blood gr - O +ve
 Non consanguineous

3. Maternal history
GDM-Controlled by diet
MSU-no growth, HVS-E. Coli
h/o PPROM-24 hrs, treated
Betamethasone given- 2 doses
ANSS- 3 independent sacs, 1st triplets with
oligohydramnious

4. Birth history
 Emergency LSCS
 Apgar score: 1’-6 and 5’-8
 Cried after birth
 Intubated in view of weak respiratory effort

5. Parameters in NICU
 Birth weight- 930 gm (50th centile)
 HC-24.5 cm (10th centile)
 Temp-36.4’C ,HR-150/min
 RR-45/min with nasal flaring and recession
 BP-47/18, MAP-29 mmHg

6. Examination
 Pink, good perfusion
 Respiratory: B/L equal air entry, recessions
present
 CVS:S1,S2 normal, No murmur
 Abdomen: soft, normal female genitalia
 CNS: anterior fontanels at level, no abnormal
movements

7. In NICU
 Respiratory support-24 days + 15 days
(invasive/non invasive)
 Chest X ray – RDS
 Surfactant- 2 doses
 IV antibiotics : 7 days (clinical grounds)
 CVS- ?PDA
 ECHO: moderate size PDA, no volume overload,
Mild pulmonary hypertension

8.  CNS- Normal for age
 Clinical jaundice: phototherapy (4days)
 Feeding: stared on day 2 →day 25. Intermittent
feed intolerance
 Day 11: packed RBC (as per the NICU guideline)

9. On day 39
 The baby was on full oral feeds
 On neoblend with low parameters
 Setback:
 Frequent apnea
 temperature instability
 bradycardia and desaturations
 Respiratory support- 12 days (invasive /non invasive)
 Chest X ray: para hilar and upper zonal haziness noted
 Septic screening : ↑ CRP (>100)  WBC,  platelets  Hb

10. Management
 PRBC and FFP
 PRBC: D11, D15, D39, D40, D42 =5
Platelet transfusion: D39, D40, D41 (total – 6)
 IV antibiotics -10 days.
 Blood smear (D 39) : positive for malaria parasite
 P. vivax ring form, gametocytes, schizonts and trophozoites
 Oral chloroquine and primaquin was given
 Repeat blood smear done after 7 days was negative
for malarial parasite.

11.  Retrospectively maternal history was reviewed
in detail (The history was non-significant ):
 Non-Endemic region
 No H/O of Blood product transfusion
 No H/O fever or malaria
 Blood bank was informed

12. Incident report
 Transfusion history for the last 2 mo of the patient
 Both donors were tested for malaria in the pre-transfusion screening and both
showed negative for malaria Ag
 Both donors was called for a repeat sample but both are unavailable
Transfusion
date
Donor Tested for
malaria Ag
Result
14/01/15 A Yes Neg
18/01/15 B Yes Neg
11/02/15 C Yes Neg
14/02/15 D Yes Neg

13.  Transient cholestasis (D39)
 USG abdomen showed
Normal size and echotexture
No intra or extra hepatic cholestasis
GB collapsed
On discharge: Baby is well, on full oral feeds,
stable and gaining weight