Bacterial contamination of whole blood–derived platelets: the introduction of sample diversion and prestorage pooling with culture testing in the American Red Cross

Benjamin, Richard J.; Kline, Linda; Dy, Beth A.; Kennedy, Jean M.; Pisciotto, Patricia; Sapatnekar, Suneeti; Mercado, Rachel; Eder, Anne F.

doi:10.1111/j.1537-2995.2008.01853.x

Cited by 68 publications

(79 citation statements)

References 20 publications

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“…These interventions each had a significant impact on contamination rates that were assessed on routine quality control testing and declined over this time, which is in line with experience reported from other centres [5][6][7].…”

Section: Resultssupporting

confidence: 63%

Bacterial Pre-Release Testing of Platelets – the Australian Red Cross Blood Service Clinical Experience

Borosak

Wood

2011

Transfus Med Hemother

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The risk of bacterial transmission by platelet transfusion has been recognised internationally as the leading residual infections transfusion risk in the last decade. We describe the clinical and logistical aspects of bacterial contamination screening of platelets introduced in Australia in early 2008. Sampling occurs at 24 h, and platelets are released to hospitals ‘negative to date’. Bacterial screening detection of initial machine-positive (IMP) and all follow-up results are notified to transfusing laboratories. Results of screening between 2008 and 2010 found a significant rate of IMP samples (1.06%) with a true- positive/indeterminate rate of 0.18%. Components were already transfused in 32.5% of cases at time of initial notification. Confirmed cases of septic transfusion reactions have declined significantly since the introduction of pre- release platelet screening, reflecting an important additional improvement in transfusion safety in Australia.

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Section: Resultssupporting

confidence: 63%

Bacterial Pre-Release Testing of Platelets – the Australian Red Cross Blood Service Clinical Experience

Borosak

Wood

2011

Transfus Med Hemother

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“…[22][23][24] Platelet components are particularly vulnerable to bacterial contamination, mainly due to their storage at room temperature, which allows growth of small inocula to very high titers and limits the shelflife of these products. 12,25 For several decades, efforts have been made at multiple levels to reduce STR and fatalities from bacterially contaminated platelet transfusions, including prevention of contamination during collection and processing, 8,26 culture of platelet products 24 hours after collection, 3,27-29 point-of-issue testing, 27,30,31 as well as pathogen-reduction technologies. 32,33 Introduction of culture of platelet products in 2004 led to a decrease in gram-negative contaminants, which had accounted for one-third of contaminants and twothirds of fatalities.…”

Section: Discussionmentioning

confidence: 99%

“…7,11 Reactions were also classified using 5 sets of STR criteria, including those from the Centers for Disease Control and Prevention (CDC) Biovigilance Guidelines 12 and recommendations from Sanders et al/St. Jude Children's Research Hospital (SJCRH), 13 ARC, 8,14 Blood Safety Surveillance and Health Care Acquired Infections Division, Public Health Agency of Canada (PHAC), 15 and AABB 5 ( Table 1). These criteria are based on the clinical features of transfusion reactions, including symptoms, observation period for onset of symptoms after platelet transfusion, and changes in vital signs.…”

Section: Str Criteriamentioning

confidence: 99%

“…7 Criteria for the diagnosis of STRs caused by bacterial contamination of platelets have been established to trigger recognition, management, and further investigation. 8 These criteria, however, broadly overlap with the diagnostic criteria for other noninfectious transfusion reactions such as febrile-like/febrile nonhemolytic transfusion reactions (FNHTRs) and hypotensive transfusion reactions. Moreover, it has been estimated that reported STR rates have been underestimated by as much as 10-fold due to limitations of passive reporting mechanisms.…”

Section: Introductionmentioning

confidence: 99%

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Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance

Hong

Xiao

Lazarus

et al. 2016

Blood

173

230

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• Bacterial sepsis from contaminated platelet transfusions continues to occur despite recent interventions; additional measures are needed.• STR to platelet transfusion is frequently not recognized or reported; use of recent AABB criteria showed highest diagnostic sensitivity.Septic transfusion reactions (STRs) resulting from transfusion of bacterially contaminated platelets are a major hazard of platelet transfusion despite recent interventions. Active and passive surveillance for bacterially contaminated platelets was performed over 7 years (2007)(2008)(2009)(2010)(2011)(2012)(2013) by culture of platelet aliquots at time of transfusion and review of reported transfusion reactions. All platelet units had been cultured 24 hours after collection and released as negative. Five sets of STR criteria were evaluated, including recent AABB criteria; sensitivity and specificity of these criteria, as well as detection by active and passive surveillance, were determined. Twenty of 51 440 platelet units transfused (0.004%; 389 per million) were bacterially contaminated by active surveillance and resulted in 5 STRs occurring 9 to 24 hours posttransfusion; none of these STRs had been reported by passive surveillance. STR occurred only in neutropenic patients transfused with high bacterial loads. A total of 284 transfusion reactions (0.55%) were reported by passive surveillance. None of these patients had received contaminated platelets. However, 6 to 93 (2.1%-32.7%) of these 284 reactions met 1 or more STR criteria, and sensitivity of STR criteria varied from 5.1% to 45.5%. These results document the continued occurrence of bacterial contamination of platelets resulting in STR in neutropenic patients, failure of passive surveillance to detect STR, and lack of specificity of STR criteria. These findings highlight the limitations of reported national STR data based on passive surveillance and the need to implement further measures to address this problem such as secondary testing or use of pathogen reduction technologies. (Blood. 2016;127(4):496-502)

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“…With the use of automated blood culture techniques, positive results are usually obtained within 24 h of inoculation for most bacterial species [28,[30][31][32]. However, it lacks a consensus on the timing and duration of culture, but it is getting more commonly used in many countries [33][34][35][36].…”

Section: Pretransfusion Detection Of Bacteriamentioning

confidence: 99%

Bacterial contamination of blood products

Lee¹

2011

ISBT Science Series

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Bacterial contamination of whole blood–derived platelets: the introduction of sample diversion and prestorage pooling with culture testing in the American Red Cross

Abstract: Sample diversion and bacterial culture are effective methods to reduce bacterial risk with WBP transfusion. Bacterial contamination of PSPs was assessed at 5.8-fold our current rate for apheresis PLTs utilizing comparable culture protocols.

Cited by 68 publications

References 20 publications

Bacterial Pre-Release Testing of Platelets – the Australian Red Cross Blood Service Clinical Experience

Bacterial Pre-Release Testing of Platelets – the Australian Red Cross Blood Service Clinical Experience

Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance

Bacterial contamination of blood products

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