Original article

Blood Transfusion 2-2018 (March - April)

Strategies for reducing the risk of transfusion-transmitted leishmaniasis in an area endemic for Leishmania infantum: a patient- and donor-targeted approach

Authors

Key words: Leishmania infantum, leucodepletion, pathogen reduction technology
Publication Date: 2017-03-15

Abstract

Background. In the Balearic Islands, as in other areas of the Mediterranean basin, there is a significant proportion of asymptomatic Leishmania (L.) infantum-infected blood donors, who may represent an important threat to transfusion safety. The Balearic Islands blood bank, located in an area endemic for L. infantum, carried out a study of donors and patients to investigate the impact of this infectious disease on blood safety in the region.
Materials and methods. Twenty asymptomatic Leishmania-infected blood donors were followed-up between 2008 and 2011 to investigate the evolution of Leishmania infection in asymptomatic carriers. Their blood was periodically tested for anti-Leishmania antibodies by western blot and for Leishmania DNA by quantitative polymerase chain reaction (qPCR). Additionally, the prevalence of L. infantum infection was investigated in a group of 68 multiply transfused patients to ascertain the risk of transfusion-transmitted leishmaniasis (TTL) in the region, taking into account regular blood component production practices such as pre-storage leucodepletion and pathogen reduction technology.
Results. All 20 donors remained asymptomatic over the study period (2008-2011). Most donors had repeatedly positive qPCR results, either persistently or intermittently, but showed no symptoms of Leishmaniasis. Levels of parasitaemia were remarkably low in asymptomatic donors, with values ≤1 parasite/mL. Despite multiple transfusions received over 15 years, no transfused patient studied was infected with L. infantum.
Discussion. L. infantum-infected donors can remain asymptomatic for at least 3 years. In our region, no cases of TTL were detected, despite an active search in multiply transfused patients. This seems to be related to two independent variables: (i) a low concentration of the parasite in the peripheral blood of asymptomatic carriers and (ii) the application of methods with proven efficacy against TTL, such as leucodepletion and pathogen reduction technology.

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Authors

Teresa Jimenez-Marco - Blood and Tissue Bank Foundation of the Balearic Islands, Majorca; University Institute for Research in Clinical Sciences (IUNICS), Majorca

Cristina Riera - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona; 4Son Llàtzer Hospital, Majorca

Enrique Girona-Llobera - Blood and Tissue Bank Foundation of the Balearic Islands, Majorca; University Institute for Research in Clinical Sciences (IUNICS), Majorca

Carmen Guillen - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

Laura Iniesta - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona;

Magdalena Alcover - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

Diana Berenguer - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

Alba Pujol - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

Miriam Tomás-Pérez - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

Beatriz Cancino-Faure - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

Teresa Serra - University Institute for Research in Clinical Sciences (IUNICS), Majorca

Martín Mascaró - Son Llàtzer Hospital, Majorca

Joan Gascó - Son Espases University Hospital, Majorca, Spain

Roser Fisa - Parasitology Laboratory, Faculty of Pharmacology, University of Barcelona, Barcelona

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