Evaluating Diagnostic Methods for Transfusion-Transmitted Malaria: RDT vs. Microscopy in Blood Donation Screening

Abstract:Background: Transfusion-transmitted malaria (TTM) remains a significant public healthconcern in malaria-endemic regions such as Ghana. The persistence of Plasmodium falciparumin donated blood, often undetected, poses a risk to transfusion recipients. This study evaluatesthe diagnostic accuracy of Rapid Diagnostic Tests (RDTs) and microscopy in detecting P.falciparum in donor blood.Aim: To compare the diagnostic performance of RDTs and microscopy in detecting P.falciparum in stored blood samples at SDA Hospital, Accra.Methods: A cross-sectional study was conducted on 115 blood samples donated to SDAHospital. The samples were screened using First Response RDT kits and Giemsa-stainedmicroscopy (gold standard). Sensitivity, specificity, and parasite density were analyzed usingSPSS version 26.Results: Of the 115 samples, microscopy detected P. falciparum in 8.7% of the cases, whileRDTs detected 6.1%. Microscopy showed 100% sensitivity and specificity, while RDTsdemonstrated 100% sensitivity and 99.1% specificity. Blood group O positive was mostfrequently associated with parasitemia. All infected donors were male, with parasite densitiesranging from 600 to 1200 parasites/µL.Conclusion: Both RDTs and microscopy showed high diagnostic performance, but microscopydetected more positive cases. Given the residual risk of TTM, integrating both diagnosticmethods in screening protocols is recommended to improve transfusion safety in malariaendemic regions.