Original Article

Blood Donor Deferrals for Malaria in Iran: A Five-Year Retrospective Study


Background: Malaria is one of the most important transfusion-transmitted infections (TTIs) worldwide. To prevent the occurrence of transfusion-transmitted malaria (TTM), potential blood donors with a history of malaria or travel to, or residence in, malarious areas are permanently or temporarily deferred from donating blood. The objective of the present study was to evaluate the blood donor deferrals for malaria in Iran.

Methods: This descriptive cross-sectional study was conducted in the Iranian Blood Transfusion Organization (IBTO) from 21 Mar 2011 to 19 Mar 2016 (5 yr). The data were collected and extracted from IBTO comprehensive database, namely Negareh, and then recorded in a structured template form. Statistical analysis was performed using SPSS.

Results: Of the 12,790,859 blood donation volunteers, 23,084 (0.18%) were deferred due to the risk of malaria. More than 90% of malaria-deferrals were because of travel to and residence in malaria endemic areas. Among the malaria-deferred volunteers, 22,139 (95.91%) were male and 945 (4.09%) were female; 2,053 (8.89%) were permanently deferred, while 21,031 (91.11%) were temporarily deferred. The highest malaria-deferral rates were observed in South Khorasan (0.82%), Razavi Khorasan (0.79%) and Yazd (0.54%) provinces, respectively.

Conclusion: Given the prevalence of malaria in neighboring countries (Pakistan and Afghanistan) and several provinces of Iran and the increasing human migration and movement between malaria non-endemic and endemic areas, the malaria-deferral rate might be higher than 0.18% in Iran. Thus, the changing, as well as the precise and accurate implementation of donor selection process must be considered in all blood transfusion centers of Iran.

Gubler DJ. Resurgent vector-borne diseases as a global health problem. Emerg Infect Dis. 1998; 4(3): 442-50.

World Health Organization. World Malaria Report 2016. Geneva: WHO; 2016. Available from: http://who.int/malaria/publications/world-malaria-report-2016/report/en/

Mollison PL, Engelfriet CP, Contreras M. Blood transfusion in clinical medicine. 10th ed. Oxford: Blackwell Science Ltd; 1997.

Woolsey G. Transfusion for pernicious anaemia: Two cases. Ann Surg. 1911; 53:132-5.

Mungai M, Tegtmeier G, Chamberland M, Parise M. Transfusion transmitted malaria in the United States from 1963 through 1999. N Engl J Med. 2001; 344(26):1973-8.

Bruce-Chwatt LJ. Transfusion malaria revisited. Trop Dis Bull. 1982; 79(10):827-40.

Bruce-Chwatt LJ. Transfusion associated parasitic infections. Prog Clin Biol Res. 1985; 182:101-25.

Nahlen BL, Lobel HO, Cannon SE, Campbell CC. Reassessment of blood donor selection criteria for United States travellers to malarious areas. Transfusion. 1991; 31(9):798-804.

Reesink HW. European strategies against the parasite transfusion risk. Transfus Clin Biol. 2005; 12(1):1-4.

Mardani A, Keshavarz H, Pourfathollah AA, Maghsudlu M. Transfusion-transmitted malaria in Iran: A narrative review article. Iran J Parasitol. 2016; 11(2):136-43.

Kinde-Gazard D, Oke J, Gnahoui I, Massougbodji A. The risk of malaria transmission by blood transfusion at Cotonou, Benin. Sante. 2000; 10(6):389-92.

Kitchen AD, Chiodini PL. Malaria and blood transfusion. Vox Sang. 2006; 90(2):77-84.

Owusu-Ofori AK, Betson M, Parry CM, Stothard R, Bates I. Transfusion-transmitted malaria in Ghana. Clin Infect Dis. 2013; 56(12):1735-41.

Silvie O, Thellier M, Rosenheim M, Datry A, Lavigne P, Danis M, et al. Potential value of Plasmodium falciparum-associated antigen and antibody detection for screening of blood donors to prevent transfusion-transmitted malaria. Transfusion. 2002; 42:357-62.

Garraud O, Assal A, Pelletier B, Danic B, Kerleguer A, David B, et al. Overview of revised measures to prevent malaria transmission by blood transfusion in France. Vox Sang. 2008; 95:226-31.

Seed CR, Kee G, Wong T, Law M, Ismay S. Assessing the safety and efficacy of a test-based, targeted donor screening strategy to minimize transfusion transmitted malaria. Vox Sang. 2010; 98:182-92.

Seed CR, Kitchen A, Davis TM. The current status and potential role of laboratory testing to prevent transfusion-transmitted malaria. Transfus Med Rev. 2005; 19(3):229-40.

Slinger R, Giulivi A, Bodie-Collins M, Hindieh F, John RS, Sher G, et al. Transfusion-transmitted malaria in Canada. Can Med Assoc J. 2001; 164:377-9.

Leiby DA. Making sense of malaria. Transfusion. 2007; 47(9):1573-7.

Leiby DA, Nguyen ML, Notari EP. Impact of donor deferrals for malaria on blood availability in the United States. Transfusion. 2008; 48(10):2222-8.

Seed CR, Cheng A, Davis TM, Bolton WV, Keller AJ, Kitchen A, et al. The efficacy of a malarial antibody enzyme immunoassay for establishing the reinstatement status of blood donors potentially exposed to malaria. Vox Sang. 2005; 88:98-106.

Pourfathollah AA, Hosseini Divkolaye NS, Seighali F. Four decades of national blood service in Iran: outreach, prospect and challenges. Transfus Med. 2015; 25(3):138-43.

Cheraghali AM. Overview of blood transfusion system of Iran: 2002-2011. Iran J Public Health. 2012; 41(8):89-93.

Abolghasemi H, Maghsudlu M, Amini Kafiabad S, Cheraghali A. Introduction to Iranian blood transfusion organization and blood safety in Iran. Iran J Public Health. 2009; 38(suppl 1):82-87.

World Health Organization. World Malaria Report 2014. Geneva: WHO; 2014. Available from: http://who.int/malaria/publications/world-malaria-report-2014/report/en/

Sadrizadeh B. Malaria in the world, in the Eastern Mediterranean Region and in Iran: review article. WHO/EMRO Report. 2001; 1:1-13.

Polizzotto MN, Wood EM, Ingham H, Keller AJ. Reducing the risk of transfusion-transmissible viral infection through blood donor selection: the Australian experience 2000 through 2006. Transfusion. 2008; 48(1):55-63.

Newman B. Blood donor suitability and allogeneic whole blood donation. Transfus Med Rev. 2001; 15:234-44.

Değirmenci A, Döşkaya M, Caner A, Nergis S, Gül K, Aydınok Y, et al. Action plan to regain unnecessary deferred blood donors due to malaria risk in Turkey. Transfus Apher Sci. 2012; 46(3):269-75.

Chiodini PL, Hartley S, Hewitt PE, Barbara JA, Lalloo K, Bligh J, et al. Evaluation of a malaria antibody ELISA and its value in reducing potential wastage of red cell donations from blood donors exposed to malaria, with a note on a case of transfusion-transmitted malaria. Vox Sang. 1997; 73(3):143-8.

Elghouzzi MH, Senegas A, Steinmetz T, Guntz P, Barlet V, Assal A, et al. Multicentric evaluation of the DiaMed enzyme-linked immunosorbent assay malaria antibody test for screening of blood donors for malaria. Vox Sang. 2008; 94:33-40.

Kitchen AD, Lowe PH, Lalloo K, Chiodini PL. Evaluation of a malarial antibody assay for use in the screening of blood and tissue products for clinical use. Vox Sang. 2004; 87:150-5.

Reesink HW, Panzer S, Wendel S, Levi JE, Ullum H, Ekblom-Kullberg S, et al. The use of malaria antibody tests in the prevention of transfusion-transmitted malaria. Vox Sang. 2010; 98:468-78.

Dodd RY. Current risk for transfusion transmitted infections. Curr Opin Hematol. 2007; 14:671-6.

O'Brien SF, Delage G, Seed CR, Pillonel J, Fabra CC, Davison K, et al. The epidemiology of imported malaria and transfusion policy in 5 nonendemic countries. Transfus Med Rev. 2015; 29(3):162-71.

IssueVol 14 No 2 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijpa.v14i2.1146
Malaria Transfusion-transmitted malaria (TTM) Blood donors Donor deferral Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
MARDANI A, KESHAVARZ H. Blood Donor Deferrals for Malaria in Iran: A Five-Year Retrospective Study. Iran J Parasitol. 2019;14(2):326-333.