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Treatment reduces malaria incidence via blood transfusion in Ghana
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Treating donated whole blood with a combination of ultraviolet radiation and vitamin B2 significantly reduced the incidence of transfusion-transmitted malaria at a hospital in Ghana, according to the results of the African Investigation of the Mirasol System, or AIMS, trial published in The Lancet.
“In many countries in sub-Saharan Africa where malaria is endemic, a high proportion of the population carry the parasite but do not show any clinical symptoms. This is particularly problematic when it comes to donated blood transfusions as it puts the recipients at high risk of infection if no blood treatment procedure is provided,” researcher Jean-Pierre Allain, MD, PhD, principal investigator in the department of hematology at the University of Cambridge, said in a news release.
“Testing for parasites such as malaria is expensive and until now, there have been no technologies capable of treating whole blood, which is most commonly used in transfusions in sub-Saharan Africa. This is the first study to look at the potential of pathogen-reduction technology in a real-world treatment setting and finds that although the risk of malaria transmission is not completely eliminated, the risk is severely reduced.”
Allain and colleagues conducted a double blind, randomized, parallel-group clinical trial at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, a country where 50% of blood donors carry the malaria-causing parasite Plasmodium. They selected adult patients with O-positive blood type who required two whole blood transfusions and were expected to be hospitalized for at least 3 days.
Between March 12, 2014, and Nov. 7, 2014, they assigned 113 patients to receive transfusions treated with the Mirasol pathogen reduction technology system (Terumo BCT), which uses UV light and vitamin B2 to reduce the pathogen load and inactivate white blood cells in blood products. The other 113 patients received transfusions using untreated blood. Pre- and post-transfusion blood samples were taken on days 0, 1, 3, 7 and 28, and tested for Plasmodium.
Among the 214 patients who completed the study, 65 previously noninfected patients were exposed to infected blood via the transfusions — 28 who received treated blood and 37 who received untreated blood. According to Allain and colleagues, the incidence of malaria was 4% among those who received treated blood compared with 22% among those who received untreated blood (P = .039).
The results “show that pathogen reduction of whole blood reduced the incidence of transfusion-transmitted malaria in a malaria endemic region while simultaneously providing clinical support in patients with severe anemia or hemorrhage,” Allain and colleagues wrote. “The primary endpoint of the study was achieved in the overall study population and in a subpopulation of patients exposed to parasitemic whole blood. The safety profile and clinical outcomes were similar across the two treatment groups.”
In a related commentary, Sheila F. O’Brien, PhD, director of national epidemiology and surveillance at Canadian Blood Services, and adjunct professor at the University of Ottawa, said the technology used by Allain and colleagues also can inactivate a “broad range” of other pathogens that are transmitted via blood transfusions, including HIV, hepatitis C virus and hepatitis B virus, and can reduce the already low risk for transmitting infections in developed countries.
Further, O’Brien wrote, pathogen reduction technology can “address concerns from emerging pathogens such as Babesia microti, West Nile virus, chikungunya virus and Zika virus.” She said the study could not have been conducted in high-income countries, where donated blood is subjected to a large number of safety measures and infection from transfusions is rare.
“Evidence that transfusion-transmitted infections in whole blood can be safely addressed by pathogen reduction technology while maintaining the clinical benefit of the transfusion underscores the potential for this treatment to revolutionize transfusion safety in Africa where it is most needed,” O’Brien wrote. – by Gerard Gallagher
Disclosures: Allain reports receiving grants from Terumo BCT. O’Brien reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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