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Transfusion-Transmitted Malaria — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsTransfusion-Transmitted MalariaSCE Infectious Diseases

A 40-year-old woman with SLE on Hydroxychloroquine develops fever, pancytopenia, and splenomegaly. Blood film shows intra-erythrocytic ring forms. She has no travel history outside Europe. She recently received a blood transfusion. What is the most likely diagnosis?

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Correct answer: D — Transfusion-transmitted malaria (or Babesia if European exposure)

Intra-erythrocytic ring forms in a non-traveller should raise suspicion for transfusion-transmitted malaria (extremely rare in the UK due to donor screening, but possible) or Babesiosis (if European tick exposure). Transfusion-transmitted malaria has been reported in the UK from donors with remote travel history. The blood transfusion history is the critical epidemiological clue. Thick and thin films with speciation, and notification to the blood transfusion service (SHOT reporting), are essential. The incubation period post-transfusion can be days to months depending on the species.

Reference: SHOT 2024 – UK Haemovigilance; UKHSA 2024 – Transfusion-transmitted infections