The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

Abstract

BCPTRs are rare yet potentially serious. The signs and symptoms of BCPTRs, and associated STRs, are not specific, posing risk of misclassification. Challenges surrounding reporting and case ascertainment underscore the need for laboratory measures to address residual risk of contamination.

Blood Utilization and Transfusion Reactions in Pediatric Patients Transfused with Conventional or Pathogen Reduced Platelets

“…11 It is widely accepted that passive surveillance PLT cultures drawn early in storage (ie, prior to release from the blood center) is an important, but ultimately inadequate, mitigation strategy for the threat posed by bacteria in PLT concentrates. [13][14][15] The incidence of bacterially contaminated PLTs was reported to be 1 in 2881 at a large hospital blood bank that inoculated cultures from PLTs at the time of receipt (day 3 or 4). 15 Various strategies have been proposed to enhance the sensitivity of PLT cultures, including additional culture time points and larger sampling volumes.…”

Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions

“…Transfusion of contaminated PLTs would result in no clinical consequences in the majority (75%) of cases . Of those clinical consequences, 44.4% would be minor and 55.6% would be serious . In this model, “serious” complications included severe, life‐threatening, or fatal reactions, as defined using the Centers for Disease Control and Prevention's National Healthcare Safety Network hemovigilance criteria.…”

“…The relative probabilities of these consequences were drawn from active surveillance data of bacterially contaminated PLTs over a 7-year period and a retrospective analysis characterizing culture-positive and septic transfusion reactions at a tertiary academic medical center. 23,24 Because it has been suggested that the overwhelming majority of septic reactions occur from contaminated units transfused on Day 4 or later, the analysis assumed contaminated units transfused on Day 3 were less likely to cause serious complications than contaminated units transfused after Day 3. 1,13,25,26 It was assumed that the processes and costs associated with transfusion would not differ across strategies.…”

“…Reported estimates of the risk of bacterial contamination of apheresis PLTs that have tested negative in primary culture vary widely and depend on the precise setting and method. 2,23,24 In the base-case analysis, it was assumed that the contamination probability in the absence of PR or secondary testing followed a beta distribution with a mean of 1/2500. 23 Transfusion of contaminated PLTs would result in no clinical consequences in the majority (75%) of cases.…”

“…23 Of those clinical consequences, 44.4% would be minor and 55.6% would be serious. 24 In this model, "serious" complications included severe, life-threatening, or fatal reactions, Standard product and nonproduct costs were obtained from published literature and were based on a hospital perspective. In the absence of PR, it was assumed that the hospital service received leukoreduced apheresis PLTs ($555.75), 31 which then underwent irradiation 32 and Zika testing.…”