Abstract: TH-PO0935
Babesia Masquerade: Hemolysis After Kidney Transplant
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Selvam, Sri Abirami, Oregon Health & Science University, Portland, Oregon, United States
- Rehman, Shehzad, Portland VA Medical Center, Portland, Oregon, United States
- Smith, Justin R., Portland VA Medical Center, Portland, Oregon, United States
Introduction
Transfusion-transmitted babesiosis is an uncommon but potentially severe infection in transplant recipients. In post-transplant patients with pre-existing hemolytic disorders, such as atypical hemolytic uremic syndrome (aHUS), Babesia infection can be difficult to distinguish due to overlapping clinical features. We describe such a case in the Pacific Northwest, where timely diagnosis—despite the region’s low incidence and absence of routine Babesia screening in non-endemic areas—led to a favorable patient outcome.
Case Description
A 32-year-old male from Seattle with ESKD secondary to anti-complement factor H antibody-associated aHUS managed with eculizumab, received a deceased donor kidney transplant in late 2023. He had immediate graft function and received standard induction with antithymocyte globulin and steroids, followed by tacrolimus-based maintenance immunosuppression (IS). Eculizumab was continued postoperatively to prevent aHUS recurrence. He required blood transfusions on postoperative days (POD) 2 and 3 due to anemia.
On POD 45, he presented with fever, headache, myalgias, and gastrointestinal symptoms. Labs showed hemoglobin of 7.5 g/dL, platelets at 158 K/μL, elevated lactate dehydrogenase at 1239 U/L, undetectable haptoglobin. Peripheral blood smear and serological testing confirmed Babesia infection. Maintenance IS was reduced, and treatment with azithromycin and atovaquone was initiated for six weeks. Subsequent investigation revealed that one of the blood donors tested positive for Babesia species.
Discussion
This case highlights the need for maintaining a broad differential while evaluating hemolysis in transplant recipients. Timely recognition of Babesia as a treatable infectious cause of hemolysis prevented unnecessary escalation of immunosuppression and protected graft function. The American Red Cross implemented comprehensive Babesia screening in endemic areas in 2020, significantly reducing transfusion-transmitted babesiosis risk. Although babesiosis is rare in the PNW—with fewer than 1 case per 100,000 population according to CDC data—transfusion-transmitted infection remains a risk when blood is sourced from regions without routine screening. Given national blood redistribution, there is a need to re-evaluate current screening policies—or, at minimum, adopt greater scrutiny when transfusing immunocompromised patients, regardless of regional endemicity