We report the case of a female newborn Valley, born and raised in Cali (Valle del Cauca), product of the second pregnancy and 27 weeks of gestation, daughter of a 25-year-old pregnant woman with preeclampsia LowLE at week 26
We decided to perform an emergency cesarean section and we obtained a female newborn weighing 800 g, size 35 cm and Apgar score 4 to 8.
She presented respiratory distress syndrome due to hyaline membrane disease that required management with orotracheal intubation, application of pulmonary surfactant, umbilical catheterization and transfer to the neonatal intensive care unit, where early respiratory sepsis was suspected, as well as antibiotic therapy.
After observing improvement of the respiratory pattern, the chest tube was removed four days later and a low flow system was maintained.
During the same period, the newborn presented hyperbilirubinemia and was treated with phototherapy.
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At six days of age, the patient developed anemia (Table 1 and respiratory impairment, which led to a possible late sepsis.
New laboratory tests were requested, antibiotic treatment was changed and the first transfusion of 12 ml of red or positive cells was ordered.
The patient showed improvement in her respiratory pattern, continued with continuous positive airway pressure and persisted with anemia, so it was decided to re-infuse 12 ml of positive red blood cells four days after the first transfusion.
The patient continued with respiratory instability and low hemoglobin levels for two weeks, which were managed with transfusions on two other occasions: at 25 days and 37 days of age, 30 ml and 33 ml of red blood cells, respectively.
Five days after the last transfusion, the patient presented an episode of decreased oxygen saturation and feverish peaks, so it was considered necessary to rule out nosocomial infection and laboratory tests were requested to find the source of the infection.
In the complete blood count requested, parasites were detected and thick blood smear was positive for P. vivax, with 58.080/μl.
Treatment was initiated with 5 mg of chloroquine daily for five days, and a satisfactory evolution was observed.
Mothers were asked about trips to endemic areas in the last six months, whatsoever, and serial thick smears were taken that were negative.
The investigation of the blood products received by the patient was initiated and a positive PCR for the same hemoparasite was found in the blood products of the third transfusion donor 17 days before the beginning of the transmission of the symptoms, which confirmed the diagnosis.
On seeing the information available about the donor, it was found that he also lived in Cali, and that nine months before the donation he had traveled to the rural area of Dagua (Valle del Cauca).
During this time he did not present malaria symptoms, so he never consulted for this reason and, when asked about the possibility of having previously suffered malaria, he mentioned it.
Two days after the patient's treatment, a negative thick smear result was obtained; an adequate evolution was observed without new fever peaks, without bleeding episodes, without clinical compromise and with hemodynamic stability, so it was decided to discharge her.
The donor received a treatment scheme with chloroquine for five days and primaquine for 15 days, and presented complete healing.
