Transfusion-transmitted malaria

Excerpt

Sir: An 81-year-old man with type 2 diabetes and coronary heart disease was admitted in August, 2002, for bleeding from a duodenal ulcer, which was successfully treated by sclerosis and a transfusion of four units of packed red cells from four different donors. Thirteen days later he was readmitted for acute fever of unknown origin, for which he received ceftriaxone. On the fourth treatment day, coma, anemia and thrombocytopenia developed and he was transferred to the ICU of another hospital. He had a coma without focal signs or neck stiffness and a fever of 38.5°C. Invasive mechanical ventilation was started and amoxicillin and acyclovir were given intravenously. A slight increase in protein (1.3 g/l) was noted in the cerebrospinal fluid. Cerebral computed tomography was normal. Blood tests showed normocytic anemia of 86 g/l without schistocytes, 16×10⁹/l platelets, 168 µmol/l creatinine, 60 µmol/l unconjugated bilirubin, 0.01 g/l haptoglobin, 880 U/l lactate dehydrogenase and 5.7 mmol/l lactic acid. Blood and urine cultures were negative. A thin blood smear was strongly positive for Plasmodium falciparum, with 15% of parasitized erythrocytes. Quinine was given intravenously starting with a loading dose, but multi-organ failure developed with brain death and a fatal cardiac arrest. …