Can Blood Transfusions Transmit Babesia to Premature Infants?
Three premature infants contracted Babesia from one blood donor
Transfusion-transmitted babesiosis can be difficult to recognize in newborns
One infant relapsed despite initial treatment
By Daniel J. Cameron, MD MPH
Can blood transfusions transmit Babesia to premature infants? A team of researchers at Yale School of Medicine described three premature infants in a single neonatal intensive care unit who contracted babesiosis from a single blood donor. Their report highlights ongoing challenges with blood donor screening, diagnosis, and management of transfusion-transmitted babesiosis in newborns.
LISTEN TO PODCAST: Three premature babies who contract Babesia from blood transfusions
Three Premature Infants Contract Babesia From One Donor
Babesia is a particularly concerning infection because it can be transmitted through donated blood. In this Yale report, three premature infants contracted Babesia from blood products traced to a single 24-year-old donor from Connecticut.1
According to Glanternik and colleagues, the donor was not identified as having babesiosis and was considered suitable for donation by the American Red Cross. His screening tests were negative for all FDA-mandated infectious disease testing.1
Two of the infants developed high-grade parasitemia. Parasitemia peaked at 13.4% in Infant A and 12.5% in Infant B. Infant C reached a peak parasitemia of 6.8%.1
Can Standard Blood Donor Screening Miss Babesia?
Yes. The blood donor in this report passed routine screening and all FDA-mandated testing before donation. Despite this, three premature infants contracted Babesia from transfused blood.
Babesiosis presents unique challenges for blood banks because infected donors may have few symptoms or no symptoms at all. As a result, they may not realize they are carrying the parasite when donating blood.
Because Babesia can survive in stored blood products, transfusion-transmitted babesiosis remains an important blood safety concern, particularly in endemic regions.
Read more about transfusion-transmitted babesiosis in the United States.
Why Premature Infants Are Especially Vulnerable
Premature infants frequently require blood transfusions and may develop symptoms that overlap with common complications of prematurity. As a result, transfusion-transmitted babesiosis can be difficult to recognize.
Fever, anemia, thrombocytopenia, and other laboratory abnormalities may be attributed to prematurity rather than infection, potentially delaying diagnosis.
Clinicians caring for newborns who have received blood products may need to consider babesiosis when routine explanations do not fully account for the infant’s clinical course.
Treatment and Relapse in a Premature Infant
All three premature infants were treated with azithromycin and atovaquone despite published recommendations favoring clindamycin and quinine.2
According to the authors, quinine was considered less desirable because of concerns regarding formulation stability and potential adverse effects in small children.1
The infants received 14 days of treatment, exceeding the 7-to-10-day treatment duration described in the Infectious Diseases Society of America guidelines.2
One Infant Relapsed 48 Days After Treatment
Despite initial improvement, Infant C relapsed 48 days after treatment.
The relapse was not initially obvious because there were no specific signs clearly attributable to babesiosis. However, a routine blood smear identified recurrent infection with 1% parasitemia.1
After retreatment, blood smears became negative by day 9, and therapy continued for a total of 23 days. None of the infants required exchange transfusions.1
Why Neonatal Babesiosis Can Be Difficult to Detect
According to the authors, neonatal babesiosis can be challenging to diagnose because its clinical manifestations and laboratory abnormalities are nonspecific and may resemble conditions frequently encountered in premature infants.
These diagnostic challenges raise several important clinical questions:
- Would a longer initial course of therapy have prevented relapse in Infant C?
- What are the consequences if babesiosis is missed because blood smears remain negative?
- How can clinicians confidently determine that infection has been fully cleared?
Additional discussion of Babesia diagnosis can be found in our article on why Babesia remains a clinical diagnosis for some patients.
Clinical Perspective
Transfusion-transmitted babesiosis remains uncommon, but cases involving newborns illustrate how difficult the infection can be to recognize. Symptoms often overlap with complications of prematurity, making a high index of suspicion important in infants who have received blood products.
This report also highlights the limitations of blood donor screening for Babesia and the challenges faced by clinicians caring for vulnerable newborns.
Frequently Asked Questions
Can Babesia be transmitted through a blood transfusion?
Yes. Babesia parasites can be transmitted through infected donor blood, even when donors have no obvious symptoms.
Can premature infants get Babesia from blood transfusions?
Yes. This Yale report described three premature infants who contracted Babesia from a single blood donor.
Why is Babesia difficult to diagnose in newborns?
The symptoms and laboratory abnormalities may resemble conditions commonly seen in premature infants.
Can Babesia relapse after treatment?
Yes. One infant in this report relapsed 48 days after treatment and required retreatment.
Can healthy blood donors unknowingly transmit Babesia?
Yes. In this report, the donor passed routine screening and was considered eligible to donate blood, yet transmission still occurred.
Clinical Takeaway
This Yale case series demonstrates that Babesia can be transmitted through donated blood despite routine donor screening. In premature infants, diagnosis may be delayed because symptoms often resemble common neonatal complications.
Clinicians should maintain a high index of suspicion for transfusion-transmitted babesiosis in newborns who have received blood products, particularly in endemic regions.
Related Articles
Congenital Transmission of Babesiosis: Two Case Reports
Transfusion-Transmitted Babesiosis Popping Up in More States
Study Raises Concerns for Babesia Patients and Blood Banks
Sweats May Be a Sign of Babesia
Reference
- Glanternik JR, Baine IL, Tormey CA, Rychalsky MR, Baltimore RS. A Cluster of Cases of Babesia microti Among Neonates Traced to a Single Unit of Donor Blood. Pediatr Infect Dis J. 2017.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
