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Background  Undesirable consequences of donor  Plasmodium falciparum  parasitaemia on stored donor blood have been reported. Therefore, it is imperative that all prospective blood donors are screened for  P. falciparum  infections using sensitive techniques. In this study, the sensitivities of microscopy, rapid diagnostic test (RDT), loop-mediated isothermal amplification (LAMP) assay and selective whole genome amplification (sWGA) technique in detecting  P. falciparum  infections in blood donors was assessed.    Methods  Randomly selected blood donors from 5 districts in Greater Accra Region of Ghana were screened for asymptomatic  P. falciparum  infections. Each donor sample was screened with SD Bioline RDT kit for  P. falciparum  histidine rich protein 2 and  Plasmodium  lactate dehydrogenase antigens, sWGA and 18s-rRNA LAMP. Crude DNA LAMP (crDNA-LAMP) was compared to purified DNA LAMP (pDNA-LAMP).    Results  A total of 771 blood donors were screened. The respective overall prevalence of  P. falciparum  in Ghana by microscopy, RDT, crDNA-LAMP, pDNA-LAMP and sWGA was 7.4%, 11.8%, 16.9%, 17.5% and 18.0%. Using sWGA as the reference test, the sensitivities of microscopy, RDT, crDNA-LAMP and pDNA-LAMP were 41.0% (95% CI 32.7–49.7), 65.5% (95% CI 56.9–73.3), 82.6% (95% CI 75.8–88.3) and 95.7% (95% CI 90.1–98.4), respectively. There was near perfect agreement between LAMP and sWGA (sWGA vs. crDNA-LAMP, κ = 0.87; sWGA vs. pDNA-LAMP, κ = 0.96), while crDNA-LAMP and pDNA-LAMP agreed perfectly (κ = 0.91). Goodness of fit test indicated non-significant difference between the performance of LAMP and sWGA (crDNA-LAMP vs. sWGA:  x  2  = 0.71, p = 0.399 and pDNA-LAMP vs. sWGA:  x  2  = 0.14, p = 0.707). Finally, compared to sWGA, the performance of LAMP did not differ in detecting sub-microscopic parasitaemia (sWGA vs. crDNA-LAMP:  x  2  = 1.12, p = 0.290 and sWGA vs. pDNA-LAMP:  x  2  = 0.22, p = 0.638).    Conclusions  LAMP assay agreed near perfectly with sWGA with non-significant differences in their ability to detect asymptomatic  P. falciparum  parasitaemia in blood donors. Therefore, it is recommended that LAMP based assays are employed to detect  P. falciparum  infections in blood donors due to its high sensitivity, simplicity, cost-effectiveness and user-friendliness.

malaria journal

Evaluating 18s-rRNA LAMP and selective whole genome amplification (sWGA) assay in detecting asymptomatic Plasmodium falciparum infections in blood donors