Diop S, Ndiaye M, Seck M, Chevalier B, Jambou R, Sarr A, Dièye T N, Touré A O, Thiam D, Diakhaté L
Centre national de transfusion sanguine, BP 5002, Dakar Fann, Sénégal.
Transfus Clin Biol. 2009 Nov-Dec;16(5-6):454-9. doi: 10.1016/j.tracli.2009.02.004. Epub 2009 Aug 7.
Malaria is a real public health problem in Africa; more than 300 million new cases and approximately two million deaths arise every year. In spite of the blood transfusion is a potential way of Plasmodium transmission, there is no consensus for measures to prevent post-transfusion malaria in endemic area. This work aimed at comparing some tools and to discuss various strategies to be implemented.
The study concerned 3001 blood donors recruited in seven blood transfusion centers in Senegal during two periods: dry season (June-July, 2003) and rainy season (October-November, 2003). We evaluated the efficiency of the selection questionnaire for the blood donors to exclude those who are potentially asymptomatic carriers of the Plasmodium. Every donation was screened for pLDH antigen and antibodies against Plasmodium by Elisa technique (DiaMed, Cressier sur Morat, Suisse), morphological tests was also performed, as well as the screening of HIV, HBs Ag, HCV Ab and syphilis.
Median age of blood donors was of 27.7 years. Anti-Plasmodium antibodies prevalence was 65.3% and pLDH antigen was of 0.53%, all positivity was confirmed by microscopy. The prevalence of the other infectious markers was 11.7% for HBs Ag; 0.83% for syphilis; 0.49% for HCV Ab and 0.46% for HIV Ab. The risk factors associated with an asymptomatic carrier of Plasmodium were: the rainy season, irregular character of the blood donations, high frequency of malaria attacks in the past, and absence of treatment during the last episode.
Plasmodium represents the third risk of blood transmitted infectious agents after hepatitis B virus, syphilis, and before HCV and HIV in Senegal. The medical questionnaire is not useful enough for asymptomatic carriers deferral, and we propose to introduce Plasmodium screening. The screening for Plasmodium pLDH by Elisa technique seems to be the best tool in endemic area and the strategy of systematic screening is the most suited in terms of blood transfusion safety.
疟疾是非洲一个切实存在的公共卫生问题；每年新增病例超过3亿例，死亡人数约200万。尽管输血是疟原虫传播的一种潜在途径，但在疟疾流行地区，对于预防输血后疟疾的措施尚无共识。这项工作旨在比较一些工具并讨论应实施的各种策略。
该研究涉及在塞内加尔的七个输血中心招募的3001名献血者，分两个时期进行：旱季（2003年6月至7月）和雨季（2003年10月至11月）。我们评估了献血者选择问卷排除潜在无症状疟原虫携带者的效率。每次献血都通过酶联免疫吸附测定技术（DiaMed，瑞士克雷西耶 - 苏尔 - 莫拉特）筛查疟原虫乳酸脱氢酶（pLDH）抗原和抗疟原虫抗体，还进行了形态学检测，以及HIV、乙肝表面抗原（HBs Ag）、丙肝抗体（HCV Ab）和梅毒的筛查。
献血者的年龄中位数为27.7岁。抗疟原虫抗体患病率为65.3%，pLDH抗原为0.53%，所有阳性均经显微镜检查确认。其他感染标志物的患病率分别为：HBs Ag为11.7%；梅毒为0.83%；HCV Ab为0.49%；HIV Ab为0.46%。与无症状疟原虫携带者相关的危险因素为：雨季、献血的不规律性、过去疟疾发作频率高以及上次发作时未接受治疗。
在塞内加尔，疟原虫是仅次于乙肝病毒、梅毒，在丙肝病毒和艾滋病毒之前的血液传播感染因子的第三大风险。医学问卷对于排除无症状携带者的作用不够大，我们建议引入疟原虫筛查。通过酶联免疫吸附测定技术筛查疟原虫pLDH似乎是疟疾流行地区的最佳工具，就输血安全而言，系统筛查策略最为合适。
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