title: An unusual febrile nonhemolytic reaction occurred after transfusion in a thalassemia major patient with asymptomatic Plasmodium falciparum infection.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: UO Ematologia 2, UO Medicina Interna IA, Centro Trasfusionale e di Immunoematologia, Laboratorio di Microbiologia, and UOS Rianimazione Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. bosch@policlinico.mi.it
authors.forename: Carla
authors.initials: C
authors.lastname: Boschetti
authors.forename: Maria D
authors.initials: MD
authors.lastname: Cappellini
authors.forename: Mariangela
authors.initials: M
authors.lastname: Colombi
authors.forename: Antonietta
authors.initials: A
authors.lastname: Villa
authors.forename: Romualdo
authors.initials: R
authors.lastname: Grande
authors.forename: Cristina
authors.initials: C
authors.lastname: Vercellati
authors.forename: Franca
authors.initials: F
authors.lastname: Radaelli
authors.forename: Luisa
authors.initials: L
authors.lastname: Caspani
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications*; D017086:beta-Thalassemia / Q000150:complications*