Kitchen A D, Chiodini P L
National Blood Service, London, UK.
Vox Sang. 2006 Feb;90(2):77-84. doi: 10.1111/j.1423-0410.2006.00733.x.
The transmission of malaria by blood transfusion was one of the first recorded incidents of transfusion-transmitted infection. Although a number of different infections have been reported to be transmitted by transfusion since then, on a global scale malaria remains one of the most common transfusion-transmitted infections. Transfusion-transmitted malaria can have serious consequences, as infection with Plasmodium falciparum may prove rapidly fatal. Ensuring that, in non-endemic countries, the blood supply is free from malaria is problematical, especially as travel to malarious areas is increasing and there is some spread of the disease into new areas, as well as a resurgence of malaria in areas where previously it had been eradicated. In non-endemic countries, donor deferral can be effective, but clear guidelines are needed. In endemic countries the problem is far greater as the majority of donors may be potentially infected with malaria parasites. In both situations, the simple deferral of donors may be wasteful and can eventually erode the donor base. Thus, other strategies are needed to ensure safety with sufficiency. However, the screening of donations for evidence of malaria is not without its problems. Although the examination of blood films is still the basis for diagnosing acute malaria, in most situations it is not sufficiently sensitive for blood bank screening. In non-endemic countries, donor deferral in combination with screening for specific antimalarial immunoglobulin provides an effective means of minimizing the risk of transmission. In endemic countries, more specific donor questioning, consideration of seasonal variation and geographical distribution may help to identify the population of donors who are most likely to be infected. In addition, the administration of antimalarials to transfusion recipients may help to prevent transmission. Nonetheless, no matter what strategy is adopted, it is likely that cases of transfusion-transmitted malaria may still occur, so malaria must always be considered in any patient with a febrile illness post-transfusion.
通过输血传播疟疾是最早有记录的输血传播感染事件之一。自那时以来，虽然有许多不同的感染据报道可通过输血传播，但在全球范围内，疟疾仍然是最常见的输血传播感染之一。输血传播的疟疾可能会产生严重后果，因为感染恶性疟原虫可能会迅速致命。在非疟疾流行国家，确保血液供应无疟疾存在问题，尤其是随着前往疟疾流行地区的旅行增加，以及该疾病向新地区的一些传播，还有在以前已根除疟疾的地区疟疾再度流行。在非疟疾流行国家，推迟献血者献血可能有效，但需要明确的指导方针。在疟疾流行国家，问题要严重得多，因为大多数献血者可能潜在感染疟原虫。在这两种情况下，单纯推迟献血者献血可能是浪费行为，最终会侵蚀献血者群体。因此，需要其他策略来确保在充足供应的情况下的安全性。然而，对献血进行疟疾检测并非没有问题。虽然检查血涂片仍然是诊断急性疟疾的基础，但在大多数情况下，它对血库筛查的敏感性不足。在非疟疾流行国家，推迟献血者献血并结合筛查特定的抗疟疾免疫球蛋白是将传播风险降至最低的有效手段。在疟疾流行国家，更具体地询问献血者、考虑季节变化和地理分布可能有助于识别最有可能感染的献血者群体。此外，给输血受者服用抗疟药可能有助于预防传播。尽管如此，无论采取何种策略，输血传播疟疾的病例仍有可能发生，因此对于任何输血后发热的患者，都必须始终考虑疟疾的可能性。
