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A transfusion transmitted infection (TTI) is a virus, parasite, or other potential

pathogen that can be transmitted in donated blood through transfusion to a recipient. Malaria

is a protozoan parasitic infection of humans resulting from one or more of the five species of

the genus Plasmodium (Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale,

Plasmodium malariae and Plasmodium knowlesi)(1). Malaria can be efficiently transmitted by

transfusion of cellular blood components and it is undoubtedly responsible for the majority of

transfusion-transmitted diseases in the world(2).

Screening for transfusion transmissible infections (TTIs) ensures that blood transfusion is

safe. Unsafe blood transfusion is damaging from both a human and an economic point of

view. Each unit of blood transfused potentially carries 1% risk of transfusion related

problems, including TTIs such as human immunodeficiency virus (HIV), hepatitis C virus

(HCV), hepatitis B virus (HBV), syphilis and malaria. In Pakistan, with an only nascent

culture of voluntary donations, a strong dependence on replacement and paid donors and the

lack of systematic screening strategy. The infection risks are formidable since the

commercially remunerated blood donors and family replacement donors are more

likely to transmit TTIs as compared to the voluntary donors. The morbidity and mortality,

resulting from transfusion of infected blood, have far reaching consequences for the

recipients and their families.

There has been a paucity of information concerning the distribution and potential role of the

different Plasmodium species in transfusion-related malaria cases, and the clinical impact of

parasitaemic blood in recipients, particularly young children and pregnant women who are
the highest consumers of blood transfusions in Pakistan. Transfusion malaria is fairly

common in endemic areas. Following an attack of malaria, the donor may remain infective

for years (1-3 years in P. falciparum, 3-4 years in P. vivax, and 15-50 years in P. malariae.)

Most infections occur in cases of transfusion of blood stored for less than 5 days and it is rare

in transfusions of blood stored for more than 2 weeks. Frozen plasma is not known to

transmit malaria(3).

When malaria is transmitted through blood transfusion to a nonimmune recipient, it can

progress rapidly and may lead to significant morbidity and mortality, specifically when

diagnosis is delayed(1,3). Epidemiologically, Pakistan is classified as a moderate malaria

endemic country with a National API averaging at 1.08 (MIS, 2015) and wide diversity

within and between the provinces and districts. Plasmodium Vivax and Plasmodium

Falciparum are the only prevalent species of parasites detected so far, with P.vivax being the

major parasite species responsible for >80% reported confirmed cases in the country.

Transfusion-transmitted malaria occurs at an estimated rate of 0.25 cases per 1 million blood

units collected(4).

The prevalence of malaria parasitaemia among consenting 308 blood donors in Ilorin was

27.3%(5). Similarly a study published in 2016, carried out at Kaduna, Nigeria reported 27

(7.5%) positive cases of malarial parasites among the blood donors(6). Total 300 blood donors

from Jamila Sultana Foundation Rawalpindi were studied and screened for the prevalence of

infectious disease. Out of these donors 4 were infected with malaria (1.6%)(7).

Keeping in view the above mentioned facts and figures I have designed my study to

determine the magnitude of malarial parasites in our local population coming to donate blood

at tertiary care hospital. The donors who are deferred due to presence of malarial parasites in

their blood will be counselled that malaria is a treatable cause and then they will be referred

to physicians for treating the parasite. Pakistan is a developing country and its dealing with a
lot of other health issues, so we have to take proper precautions to make blood transfusion

safe and uneventful in regards to malarial parasite. The result of this study will also be shared

with other professionals to aware them regarding current situation so they can plan their

strategies accordingly and more effectively.


To determine the frequency of malaria in blood donors in tertiary care hospital.

Operational Definition:

Malaria Infection:

Malaria is an infectious disease characterized by cycles of chills, myalgia, headache, fever (

100.4 F - 105 F) and sweating, caused by a protozoan of the genus Plasmodium in red blood

cells, diagnosis depends primarily on the identification of Plasmodium in thick and thin blood

smears and is transmitted to humans by the bite of an infected female anopheles mosquito.


A person who gives his or her blood to be used for transfusion for the first time.

Study Design:

Descriptive, cross-sectional study


Department of Pathology, Hayatabad Medical Complex

Study Duration:

Six months from the date of approval by CPSP, Karachi.

Sampling Technique:

Consecutive (Non-probability) sampling

Sample Size: Sample size will be 218 with 95% confidence interval, 3.5% margin of error

and keeping 7.5% proportion of Malaria in donors 7 under WHO sample size calculator.

Inclusion criteria:

1. Either gender

2. Age 18- 65 years.

3. Blood Donor

Exclusion criteria:

1. Weight <50 kilograms assessed on weight machine.

2. History of blood donations within 3 months confirmed from medical records.

3. Pregnant and Lactating Women based on clinical medical records.

Data Collection Procedure:

Study will be approved by CPSP. All the individuals presenting with the primary intention of

donating blood without compensation will be interviewed by me in the Blood Bank unit of

haematology Department. The purpose and procedure of the study will be explained and an

informed consent will be obtained from the blood donor justifying the inclusion criteria and
allotted a donor ID number which will be noted.03 ml venous blood of the donor will be

collected in an EDTA containing vacutainer, after following aseptic techniques of blood

collection. The complete blood count will be obtained with the help of Cell dyn ruby

analyser. Giemsa stained thick and thin blood films will be made from each donor blood and

will be examined under x100 objective lens (immersion oil) using a light microscopy to

identify and detect Plasmodium parasites (trophozoites, schizontes, gametocytes, and malarial

pigment in neutrophils and monocytes) demographic and clinical data of all patients

including age, gender, address, occupation and malarial parasite present or absent will be

recorded and entered into a predesigned proforma.


The study will be analyzed using SPSS version 17 for windows. The frequency and

percentages will be calculated for the categorical variables such as gender, marital status,

dwelling, education, occupation, history of blood transfusion, history of fever in past six

months and history of travel in past six months while the numerical variable such as age and

frequency of blood transfusion will be presented with mean +SD. Malaria will be stratified
among age, gender, history of blood transfusion, dwelling, education, occupation, history of

fever in past six months and history of travel in past six months to see the effect modification.

Post stratification chi-square test will be applied keeping p-value ≤ 0.05 as significant. All the

data will be presented in the form of tables and graphs.


1. Munir MA, Qureshi H, Safdar N. Malaria indicator survey in 38 high risk districts of
Pakistan - Pakistan Medical Research Council, Ministry of Health, Government of
Pakistan MIS Report 2013-2014.
2. Gharehbaghian A. An estimate of transfusion-transmitted infection prevalence in
general populations. Hepat Mon. 2011;11(12):1002.
3. Attaullah S, Khan S, Khan J. Trend of transfusion transmitted infections frequency in
blood donors: provide a road map for its prevention and control. J Transl Med.
4. Amer A, Al Malki A, Yousef B, Al Mutawa H. Improved screening of donor’s blood
for malaria: A qatari experience. Qatar Med J. 2005;2005(2):9.
5. Olawumi HO, Fadeyi A, Babatunde SK, Akanbi II AA, Babatunde AS, Sani MA, et al.
Malaria parasitaemia among blood donors in Ilorin, Nigeria. African J Infect Dis.
6. Garba D, Ameh J, Whong C, Mukhtar M.
Prevalence of malaria parasites among blood donors in Kaduna, Nigeria Int J Res Med
Sci. 2016;6(4):2114.
7. Kamran M, Mahmood RT, Khan MA, Mehmood A, Nisar L, Asad MJ.
Prevalence of transfusion transmitted infections among blood donors; a prospective
study. Am J Phytomed Clin Theur. 2014;2(4):540–3.





Serial no:______________ Contact no: _____________________

Name:_________________________ Age:______

Gender: Male ______ Female ______

Marital status: Married: ______ Unmarried ______

Dwelling: Urban: ______ Rural _______


Education: _________________________________

History of blood transfusion: Yes _____ No _____

Frequency of blood transfusion: _______________________________________

History of fever in past six months: Yes _____ No _____

History of travel in past six months: Yes _____ No _____

Malarial parasite: Yes _____ No _____

Signature of medical officer:____________