[Post-transfusion malaria: is the risk irreconciliable with biological silence?]

Area of Science:

• Transfusion Medicine
• Infectious Diseases
• Parasitology

Background:

• Imported malaria is frequent in metropolitan France, posing a potential risk for transfusion transmission.
• Current screening of blood donors relies on interviews and serology, but these methods have limitations in accurately identifying individuals at risk for malaria.
• Transfusion-transmitted malaria can be lethal, highlighting the need for robust screening protocols.

Purpose of the Study:

• To evaluate the adequacy of current serology testing for detecting Plasmodium-infected donations, particularly by Plasmodium falciparum.
• To explore alternative screening methods and their associated costs.
• To assess the overall risk of transfusion-transmitted malaria and potential mitigation strategies.

Main Methods:

• Review of existing screening protocols for blood donations in metropolitan France.
• Analysis of the sensitivity and limitations of serological tests for Plasmodium detection.
• Consideration of alternative biological qualification methods and plasma donation as a risk-reduction strategy.

Main Results:

• Current pre-donation interviews are not fully effective in excluding at-risk donors.
• Biological screening methods, including serology, lack sufficient sensitivity due to methodological challenges and the complexity of Plasmodium and host immune responses.
• The risk of transfusion-transmitted malaria is not entirely eliminated by existing measures.

Conclusions:

• Serology testing may not be the most adequate method to prevent Plasmodium-infected donations, especially from Plasmodium falciparum.
• Plasma donation circulation could minimize transfusion risks for both donors with actual and presumed risk.
• Further investigation into alternative screening methods and cost-effectiveness is warranted to enhance blood safety.