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Babesia Infection from Blood Transfusion

  • 58-year-old man with metastatic esophageal cancer was admitted to a hospital for evaluation of hematemesis and normocytic anemia
  • He had hypotension without fever, joint swelling, headache, or rash
  • His hemoglobin was 8.4 mg/dL, he had a platelet count of 71,000/mm3, and a leukocyte count of 3.5 × 103/mm3 with 19% bands
  • On a manual differential count Babesia spp. was identified
  • PCR analysis was positive and highly specific for B. microti DNA
  • He was treated with azithromycin and atovaquone for 7 days, given 2 blood transfusions for anemia, and discharged in stable condition
  • He had received 6 units of packed red blood cells and 2 units of fresh frozen plasma over several visits beginning a month earlier
  • The probable donor was a 49-year-old male who lived in Maine near an area where the tick is found and babesiosis has been diagnosed
  • The donor reported an illness 4 months before donating blood but was not tested for Babesia spp.
  • He was asymptomatic at the time of donation
  • There is no FDA approved test for Babesia spp. in blood products