How do I investigate septic transfusion reactions and blood donors with culture‐positive platelet donations?

Eder, Anne F.; Goldman, Mindy

doi:10.1111/j.1537-2995.2011.03083.x

Cited by 43 publications

(44 citation statements)

References 27 publications

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“…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%

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

Hong

Xiao

Lazarus

et al. 2016

Blood

174

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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Section: Str Criteriamentioning

confidence: 99%

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

Hong

Xiao

Lazarus

et al. 2016

Blood

174

230

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“…As S. bovis associates with colonic adenoma, whether the bacteria may play a promoter role remains to be elucidated. Besides, a recent review also suggested that different mechanisms including cytokine‐dependent inflammation, induction of uncontrolled cellular proliferation, promotion of early preneoplastic lesions, and alteration of the gut microflora environment might be involved in the bacteria‐colonic carcinogenesis . Furthermore, the linkage may also be related to the biologic characteristics of the organisms.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed if S. bovis is implicated in blood transfusion, serious clinical sequel could occur in transfusion recipients . Besides, it has been shown that asymptomatic S. bovis bacteremia could also be associated with serious donor health . Therefore, with this in mind, we review our 14 years of routine BST data and report on the clinical outcome of a series of 16 asymptomatic blood donors with asymptomatic S. bovis bacteremia in their donated blood.…”

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confidence: 99%

Long‐term clinical outcomes after Streptococcus bovis isolation in asymptomatic blood donors in Hong Kong

Lee¹,

Chan

et al. 2013

Transfusion

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“…Although septic transfusion reactions are rare and most diagnosis of TRALI are likely correct, these cases demonstrate that a septic transfusion reaction should be considered in the differential diagnosis of patients with TRALI, especially if the patient has clinical features of sepsis such as hypotension, leucopenia and fever. Early consideration of a septic transfusion allows initiation of an appropriate clinical and laboratory investigation(10) and timely treatment for sepsis including the use of pre-emptive broad-spectrum antibiotic therapy. Although specific policies and protocols differ between blood banks, notification of suspected TRALI might only ensure co-components of the implicated products are not transfused to the same patient, whereas notification of a possible septic transfusion reaction would result in quarantine of co-components from release to any patient.…”

Section: Discussionmentioning

confidence: 99%

Two septic transfusion reactions presenting as transfusion-related acute lung injury from a split plateletpheresis unit

Rollins

Molofsky²,

Nambiar³

et al. 2012

Critical Care Medicine

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Objectives We report two simultaneous cases of Staphylococcus aureus sepsis initially consistent with and diagnosed as transfusion related acute lung injury (TRALI). The sepsis in both cases resulted from transfusion of two split products from a single contaminated plateletpheresis unit. In each case the platelets were given along with numerous other blood products during posterior spine surgery. The discussion includes presentation, clinical course, diagnosis and similarities between sepsis and TRALI. The cases and discussion highlight the importance of considering sepsis as part of the differential for any patient believed to have TRALI with clinical features of sepsis. Data Sources Data were collected from the patients’ electronic medical records and the hospital laboratory medicine database. Conclusions Our cases highlight the importance of vigilant investigation in patients suspected of TRALI, as septic transfusions are easily missed and may mimic or coexist with TRALI. Sepsis should be strongly considered whenever clinical features such as hypotension, leucopenia and fever are noted in patients with suspected TRALI. In comparison to patients receiving red blood cells or plasma, platelet transfusion recipients are at a greater risk for sepsis from a contaminated unit. Patients developing sepsis from a contaminated blood product may meet the clinical definition of TRALI. In such cases, if the clinical syndrome is attributed solely to TRALI and bacterial sepsis is not suspected, the correct diagnosis may be missed or delayed. Consequently, appropriate treatment for sepsis would also be delayed or not provided and likely result in increased morbidity and mortality.

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How do I investigate septic transfusion reactions and blood donors with culture‐positive platelet donations?

Cited by 43 publications

References 27 publications

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

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

Long‐term clinical outcomes after Streptococcus bovis isolation in asymptomatic blood donors in Hong Kong

Two septic transfusion reactions presenting as transfusion-related acute lung injury from a split plateletpheresis unit

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