The negative secondary test for bacterial contamination: reducing the risk of septic transfusion reactions from platelets

Transfusion ◽  
2017 ◽  
Vol 57 (8) ◽  
pp. 2054-2055 ◽  
Author(s):  
Peter A. Tomasulo ◽  
Michael R. Jacobs
Keyword(s):  
Bacterial Contamination ◽  
Transfusion Reactions

Apheresis technology correlates with bacterial contamination of platelets and reported septic transfusion reactions

Transfusion ◽  
2017 ◽  
Vol 57 (12) ◽  
pp. 2969-2976 ◽  
Author(s):  
Anne F. Eder ◽  
Beth A. Dy ◽  
Barbara DeMerse ◽  
Stephen J. Wagner ◽  
Susan L. Stramer ◽  
...  
Keyword(s):  
Bacterial Contamination ◽  
Transfusion Reactions

scholarly journals Hazards of Bacterial Contamination of Blood Products

1993 ◽  
Vol 21 (1) ◽  
pp. 20-23 ◽  
Author(s):  
T. Gottlieb
Keyword(s):  
Bacterial Contamination ◽  
Skin Surface ◽  
Blood Products ◽  
Gram Positive ◽  
Viral Pathogens ◽  
Gram Negative ◽  
Safe Blood ◽  
The Third World ◽  
Collection Practice ◽  
Transfusion Reactions

Post-transfusion bacterial sepsis is infrequent. It is, however, associated with a high mortality due to septic shock. This reflects the release of endotoxin from gram negative bacteria. Lesser transfusion reactions are usually under-reported. These are frequently caused by gram positive bacteria. Gram positive species such as staphylococci and other skin surface organisms may be cultured from platelets stored at room temperature. Typically, gram negative “psychrophyllic” species which survive storage at 4°C are cultured from stored refrigerated blood implicated in transfusion reactions. These include Yersinia enterocolitica, Pseudomonas fluorescens etc. Bacterial contamination of the blood supply can occur via an endogenous or an exogenous source. Endogenous donor bacteraemia due to Y.enterocolitica may be asymptomatic or may follow an episode of gastroenteritis. Exogenous infections occur through some defect in the usual collection practice. Transfusion-acquired syphilis is now extremely uncommon. In the third world, beside the need for effective screening for viral pathogens, infections with protozoa, in particular plasmodia, trypanosoma and leishmania remain a major obstacle to ensuring safe blood supplies. Prevention of transfusion reactions demands rigorous attention to details of collection, storage, reissuing and infusion of blood products, as well as prompt treatment, testing and reporting of suspected reactions.

scholarly journals Post-Transfusion Fevers and Post-Reaction Culture Practices at a Large Academic Hospital Transfusion Service: Quality of Information and Calculated Bacterial Contamination Event Rates

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3569-3569
Author(s):  
Christine M. Cserti-Gazdewich ◽  
Jacob M Pendergrast ◽  
Yulia Lin ◽  
Jeannie Callum ◽  
Lani D. Lieberman ◽  
...  
Keyword(s):  
Bacterial Contamination ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Final Diagnosis ◽  
University Hospital ◽  
Cancer Center ◽  
Case Review ◽  
Large Hospital ◽  
Transfusion Reactions

Abstract Introduction: The extent to which febrile transfusion reactions (FTRs) are investigated is the extent to which bacterial contamination (BaCon) may be ascertained; FTR rates in turn vary with policies concerned with their recognition and approach. Microbiology and serology aim to rule out contamination or incompatibility, both potentially fatal. BaCon and acute hemolytic transfusion reactions (AHTR) followed transfusion related lung injury (TRALI) as the leading causes of transfusion-related death in the US in 2013 (FDA: 59 fatalities: 38% TRALI, 15% AHTR, 10% BaCon). Timely BaCon recognition enables interdiction/examination of sister products, while highlighting contamination points in the work sequence. The quality and quantity of hemovigilance data from a large hospital transfusion service were reviewed with respect to overall component utilization, adverse events, and patient/product microbiology, so as to gain a contemporary estimate of BaCon. Methods: The blood transfusion laboratory (BTL) of the tertiary care, 767-bed university hospital is supplied by Canadian Blood Services and managed by a team of technologists, a transfusion safety officer (TSO), and transfusion medicine specialists (TM MDs). Patient Reaction Events (PRE) reported to the BTL were logged over a 5 year period alongside components transfused (red cell units [pRBC], adult dose platelet concentrates [APC], frozen plasma [FP], and cryoprecipitate [crpt]). By policy, PRE are reported and formally investigated, with quarterly analyses. Roughly 3% of product recipients experience a PRE, and 40% are febrile in nature. Patient sampling is discouraged for "lower risk" fevers (asymptomatic Tmax <39C), whereas "high risk" fevers (Tmax >39C or major symptoms and/or vital sign disturbances) call for cultures of the patient and implicated product(s), as well as AHTR testing. TSO and TM MD review ensue to conclude product imputability, event severity, and final diagnosis. Definite BaCon (Def-BaCon) is defined as product and patient positive (+) for the same microbe, Probable BaCon (Prob-BaCon) as product (+) [but patient negative or untested], and Possible BaCon (Poss-BaCon) as patient (+) [but product negative or untested]. Poss-BaCon was re-classified to high-imputability (Hi-Imp Poss-BaCon) if case review failed to discover a more likely pre-existing source. Results: Between 1/1/2010 to 31/12/2014, 1,624 PRE occurred through 290,044 components dispensed (175,542 pRBC, 43,187 APC, 58,235 FP, 13,080 crpt). Patient cultures occurred in 617 (38%) of PRE, and product cultures occurred in 406 (25%) of PRE. BaCon rates varied significantly according to concluded certainty, with significant re-scaling of poss-BaCon after careful case review (Table).Table 1.rate (95% confidence interval):rate per culturerate per patient reaction event (PRE)rate per component dispensedDef-BaCon (4 cases)0.65% (0.26-1.6)0.25% (0.10-0.63)1.4 x 10^-5 (0.6-3.5) or 1 in 72,511Prob-BaCon (13 cases)3.2% (1.9-5.4) (products)0.80% (0.47-1.4)4.5 x 10^-5 (2.6-7.7) or 1 in 22,311Poss-BaCon (96 cases)15.6% (12.9-18.6)5.9% (4.9-7.2)3.3 x 10^-4 (2.7-4.0) or 1 in 3,021Hi-Imp Poss-BaCon (14 cases)2.3% (1.4-3.8)0.86% (0.52-1.4)4.8 x 10^-5 (2.9-8.1) or 1 in 20,717 Discussion/Conclusions: These data illustrate practical limits to deducing BaCon rates, despite robust hemovigilance. Def-BaCon was rare (1 in 72,511), while Prob-BaCon and Hi-Imp Poss-BaCon were more frequent at ~1 in 20,000. Current as-practiced tools in FTR/BaCon investigation are flawed at various levels. Underestimates stem from under-culturing and test sensitivity, and overestimates occur with incomplete case review for true sources of bacteremia, with Poss-BaCon as high as 1 in 3000. The MD Anderson Cancer Center (Ricci, et al 2014) reported on 999 reactions, with 738 (74%) in 642 central venous catheter (CVC) patients; 606 were cultured within a week of reaction, and 60 (9.9%) were bacteremic. Fevers were concluded to more likely represent the unmasking of CVC colonization rather than BaCon. Systematically incorporating (and adjusting for) CVC data may thus help to reduce inflationary poss-BaCon rates. On the other hand, more rigorous product testing (with biofilm studies) may scale BaCon rates upwards. Clinicolaboratory studies are needed to clarify the true relationship between febrile reactions, bacterial sources, and their significance. Disclosures No relevant conflicts of interest to declare.

scholarly journals Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

Transfusion ◽  
2016 ◽  
Vol 56 (8) ◽  
pp. 1951-1959 ◽  
Author(s):  
Heather A. Hume ◽  
Henry Ddungu ◽  
Racheal Angom ◽  
Hannington Baluku ◽  
Henry Kajumbula ◽  
...  
Keyword(s):  
Platelet Transfusion ◽  
Bacterial Contamination ◽  
Sub Saharan Africa ◽  
Transfusion Therapy ◽  
Sub Saharan ◽  
Transfusion Reactions

Inpatient Non-Hemolytic Delayed Serologic Transfusion Reactions and Hospital Length of Stay: Is There an Association?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2633-2633
Author(s):  
Matthew Yan ◽  
Christine Cserti-Gazdewich
Keyword(s):  
Acute Lung Injury ◽  
Length Of Stay ◽  
Lung Injury ◽  
Bacterial Contamination ◽  
Transfusion Reaction ◽  
Academic Hospital ◽  
Significant Difference ◽  
Hemolytic Transfusion Reaction ◽  
Circulatory Overload ◽  
Transfusion Reactions

Introduction Anti-erythroid antibodies are the classical marks of serologic and hemolytic transfusion reactions. These reactions can occur acutely or in a delayed timeframe, while the sensitizing antibody may derive from the host or be passively acquired. In those with concurrent hemolysis, the red blood cell (RBC) breakdown may be severe enough to command supportive care. However, in those with non-hemolytic delayed serologic transfusion reactions (NH-DSTRs), the threat applies more towards the future rather than the present time. Downstream hazards range from hemolytic disease of the newborn, to delays and difficulties sourcing antigen-negative blood (when the antibody is known), or an anamnestic response with higher odds of hemolysis on antigen re-exposure (when the antibody becomes unknown by evanescence and healthcare fragmentation). Data are lacking on inpatient outcomes associated with discovering a new NH-DSTR during a hospital admission. A review of NH-DSTRs was thus performed in a large academic hospital (34,000 RBC dispensations annually). Methods A retrospective review of a transfusion reaction database was undertaken at a large academic hospital in Toronto, Canada. Transfusion reactions (TRs) occurring during inpatient admissions (excluding emergency room and outpatient visits) from 1/1/2010-31/12/2015 were included. NH-DSTR was defined as the presence of a new antibody on repeat screen post transfusion with no evidence of hemolysis. Other anti-RBC antibody mediated TRs included acute hemolytic transfusion reactions (AHTR) (both host-derived and passively-acquired [from products such as intravenous immunoglobulin]), and delayed hemolytic transfusion reactions (DHTR) occurring with or without serologic findings. A comparison was also made against all inpatient TRs not due to RBC antibodies (non-anti-RBC TRs). Disturbances deemed unrelated to transfusion were excluded. Outcomes included length of stay (LOS), interval between TR recognition and discharge, severity of TR (as per the International Society of Blood Transfusion grading system), and death. Results A total of 783 inpatient TRs were reviewed. The distribution of TRs (Figure 1) included 562 (71.8%) non-anti-RBC TRs and 221 (28.2%) anti-RBC TRs. Within the anti-RBC TRs, 159 (71.9%) were classified as NH-DSTRs. The mean age of all patients was 57 (± 17) with 49.4% of reactions occurring in females. Compared with non-anti-RBC and other anti-RBC transfusion reactions, NH-DSTRs were significantly less frequently classified as severe (Table 1). The overall LOS and remaining days in hospital after TR were significantly longer in those with NH-DSTRs compared with the two other groups (Table 1). Post-reaction LOS was longer by a median of 5 or 7 days for NH-DSTR versus non-anti-RBC TRs and other anti-RBC TRs respectively. There was no significant difference between groups when evaluating inpatient mortality. Conclusions NH-DSTRs are associated with a longer LOS when compared with all other TRs. This relationship holds even in comparisons with other anti-RBC TRs. Causality is not established by this analysis, nor is there a biologic rationale for a NH-DSTR to directly impact LOS. However, the propensity to form a new anti-RBC antibody may reflect an underlying pro-inflammatory comorbid state that itself may be influencing LOS. Further studies are needed to confirm this association. Nevertheless, given any potential for additional/current impacts beyond future ramifications, the precautionary principle is strengthened for the value of curating the full extent of a recipient's antibody history, and prophylactically matching for minor antigens if resources permit. Table 1 Comparison of outcomes between NH-DSTRs versus non-anti-RBC TRs and other-anti-RBC TRs. Table 1. Comparison of outcomes between NH-DSTRs versus non-anti-RBC TRs and other-anti-RBC TRs. Figure 1 Frequency of transfusion reactions from January 1, 2010 to December 31, 2015. Abbreviations: allergic transfusion reaction (ATR), febrile non-hemolytic transfusion reaction (FNHTR), transfusion associated circulatory overload (TACO), transfusion associated dyspnea (TAD), bacterial contamination (BaCon), transfusion related acute lung injury (TRALI), inflammatory transfusion reaction (ITR), citrate reaction (CR), acute passive serologic/hemolytic transfusion reaction (APSHTR). Figure 1. Frequency of transfusion reactions from January 1, 2010 to December 31, 2015. Abbreviations: allergic transfusion reaction (ATR), febrile non-hemolytic transfusion reaction (FNHTR), transfusion associated circulatory overload (TACO), transfusion associated dyspnea (TAD), bacterial contamination (BaCon), transfusion related acute lung injury (TRALI), inflammatory transfusion reaction (ITR), citrate reaction (CR), acute passive serologic/hemolytic transfusion reaction (APSHTR). Disclosures No relevant conflicts of interest to declare.

Transfusion Reactions Due to Bacterial Contamination of Blood and Blood Products

1991 ◽  
Vol 13 (2) ◽  
pp. 307-314 ◽  
Author(s):  
Gabriel Morduchowicz ◽  
Silvio D. Pitlik ◽  
David Huminer ◽  
Michael Alkan ◽  
Moshe Drucker ◽  
...  
Keyword(s):  
Bacterial Contamination ◽  
Blood Products ◽  
Transfusion Reactions
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