An unusual febrile nonhemolytic reaction occurred after transfusion in a thalassemia major patient with asymptomatic Plasmodium falciparum infection

Carla Boschetti, Maria D. Cappellini, Mariangela Colombi, Antonietta Villa, Romualdo Grande, Cristina Vercellati, Franca Radaelli, Luisa Caspani, Alberto Zanella

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Febrile nonhemolytic transfusion reactions occur in 0.12% of transfusions, usually during transfusion or within 4 to 6 hours after transfusion and are not medically dangerous. CASE REPORT: A patient with thalassemia from Togo with asymptomatic malaria in which the infection became clinically manifest only after blood transfusion, mimicking a febrile nonhemolytic transfusion reaction, is presented. Thirty-two hours after transfusion of 2 O D-red blood cell (RBC) units, the patient (phenotype A 2 D+) developed fever and multiorgan failure and was admitted to the intensive care unit. Direct and indirect antiglobulin tests were negative on posttransfusion samples. Blood cultures and infectious diseases testing were negative. No malaria parasites were found at thick blood smear microscopic examination on Days 1 and 2 and the malaria rapid diagnostic test gave inconsistent results. Plasmodium total antibodies were detected in the serum at high levels. On Day 5, routine microscopic examination of blood smear revealed the presence of parasites in a very small number of RBCs. This finding was almost simultaneous to the availability of polymerase chain reaction testing results that were positive for P. falciparum. The sequential agglutination with anti-A antiserum allowed patient's and donors' RBCs to be separated and revealed that the parasitized cells were almost exclusively those of donors (14.4% vs. 0.029%). Malaria infection in implicated donors was excluded. CONCLUSION: In this patient with thalassemia with asymptomatic malaria, the infusion of two normal RBC units provided a favorable environment for a rapid parasite replication leading to a dramatic acute malaria attack.

Original languageEnglish
Pages (from-to)469-472
Number of pages4
JournalTransfusion
Volume51
Issue number3
DOIs
Publication statusPublished - Mar 2011

Fingerprint

beta-Thalassemia
Plasmodium falciparum
Malaria
Fever
Coombs Test
Parasites
Thalassemia
Tissue Donors
Erythrocytes
Togo
Plasmodium
Hematologic Diseases
Agglutination
Infection
varespladib methyl
Routine Diagnostic Tests
Blood Transfusion
Communicable Diseases
Intensive Care Units
Immune Sera

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

An unusual febrile nonhemolytic reaction occurred after transfusion in a thalassemia major patient with asymptomatic Plasmodium falciparum infection. / Boschetti, Carla; Cappellini, Maria D.; Colombi, Mariangela; Villa, Antonietta; Grande, Romualdo; Vercellati, Cristina; Radaelli, Franca; Caspani, Luisa; Zanella, Alberto.

In: Transfusion, Vol. 51, No. 3, 03.2011, p. 469-472.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Febrile nonhemolytic transfusion reactions occur in 0.12{\%} of transfusions, usually during transfusion or within 4 to 6 hours after transfusion and are not medically dangerous. CASE REPORT: A patient with thalassemia from Togo with asymptomatic malaria in which the infection became clinically manifest only after blood transfusion, mimicking a febrile nonhemolytic transfusion reaction, is presented. Thirty-two hours after transfusion of 2 O D-red blood cell (RBC) units, the patient (phenotype A 2 D+) developed fever and multiorgan failure and was admitted to the intensive care unit. Direct and indirect antiglobulin tests were negative on posttransfusion samples. Blood cultures and infectious diseases testing were negative. No malaria parasites were found at thick blood smear microscopic examination on Days 1 and 2 and the malaria rapid diagnostic test gave inconsistent results. Plasmodium total antibodies were detected in the serum at high levels. On Day 5, routine microscopic examination of blood smear revealed the presence of parasites in a very small number of RBCs. This finding was almost simultaneous to the availability of polymerase chain reaction testing results that were positive for P. falciparum. The sequential agglutination with anti-A antiserum allowed patient's and donors' RBCs to be separated and revealed that the parasitized cells were almost exclusively those of donors (14.4{\%} vs. 0.029{\%}). Malaria infection in implicated donors was excluded. CONCLUSION: In this patient with thalassemia with asymptomatic malaria, the infusion of two normal RBC units provided a favorable environment for a rapid parasite replication leading to a dramatic acute malaria attack.",
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AU - Grande, Romualdo

AU - Vercellati, Cristina

AU - Radaelli, Franca

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AU - Zanella, Alberto

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