日本における輸血マラリア　血小板輸血により感染したと考えられる熱帯熱マラリア１症例を中心に

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  • A case of accidental transmission of Plasmodium falciparum through platelet transfusion.

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[Case] The patient was a Japanese female, 70 years of age, living in Funabashi, Chiba, and had never been abroad. The woman was suffering from thrombocytopenia and received a total of 60 units of platelet concentrate during the period, 4-13 April, 1991. On April 24, she manifested a fever of 39°C which was successfully treated with Voltaren SuppoTM, a non-steroidal anti-inflammatory drug. Her body temperature remained normal until May 1, when she suddenly developed symptoms of cerebral malaria, liver and renal dysfunctions. In the early morning of May 2, she lost consciousness and went into cardiac arrest. Giemsa stained thin blood smears obtained for blood cytological examination which were kept at the laboratory of the hospital, later revealed that she had contracted Plasmodium falciparum malaria. The parasitemia from examination of the slides were 0% on April 2, 0% on April 17, 0.06% on April 25, 5.5% on May 1 and 1.9% just before her death on May 2. Antibody titers against P.f. antigen were < 1 : 4 on April 25, 1 : 256 on May 1 and May 2. These parasitological and serological results confirmed that she accidentally received transmission of P. f. through platelet transfusion.<BR>The possibility of transmission of malaria through platelet transfusion has been discussed by Fajardo and Tallent (1974), who showed the existence of the parasite in a platelet of a P. v. infected patient by electron microscopy. Nevertheless, since platelet packs may contain some red blood cells, parasites could be carried by erythrocytes, platelets or both. Still, this report is the first case of induced malaria resulting from platelet transfusion, and the 75th case of transfused malaria in Japan since 1935.<BR>As the number of Japanese who went abroad and of foreigners who entered Japan increased, so did the number of imported malaria cases, which were reported to be not less than 100 in 1993. Therefore malaria is no longer recognized as a very rare disease in Japan, and the risk of transfused malaria from donors who have come back from malaria endemic places has to be taken into careful consideration. To date, routine examinations on blood supplied at Blood Centers are for hepatitis B and C, syphilis, adult T cell leukemia, and AIDS, but not for malaria. The questionnaire which is used in obtaining the medical history of donors rarely includes inquiries on a past history of malaria. Special attention has to be made for the safety of blood transfusion, reminding the danger of malaria transmission.

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