Infectious reactions
Several infectious agents are transmissible by blood transfusion. Viruses, bacteria and parasites are responsible for transfusion-transmitted diseases.
Select an infectious reaction from the menu for more information:
Stop transfusion immediately once you suspect a septic reaction. Follow other steps for managing suspected transfusion reactions.
Seek urgent medical assistance as this may become an emergency.
Send blood pack to the Transfusion Service Provider for urgent culture and Gram stain.
Notify Transfusion Service Provider to contact the Blood Service to ensure quarantining and testing of related components from the same donation/donor.
Bacterial infection
When to suspect this adverse reaction?
The onset of high fever, severe chills, hypotension or circulatory collapse during or soon after transfusion should suggest the possibility of bacterial contamination and/or endotoxin reaction.
This reaction can be acute, severe and fatal.
For clinically apparent reactions, bacterial infections are variously reported to occur in at least 1:75,000 for platelets (1) and at least 1:500,000 for red cells.
Bacterial infection is more common with:
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platelets (as these are stored at room temperature)
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previously frozen components thawed by immersion in a water bath
- red cell components stored for several weeks
Usual causes?
Bacteria may enter the blood during collection or preparation of components.
It is occasionally due to contamination of ports during thawing of frozen products in a water bath. Both gram-positive and gram-negative organisms have been identified.
Organisms capable of multiplying at low temperatures and those using citrate as a nutrient are most often associated with red cell contamination, especially Yersinia enterocolitica.
Investigation
Clinically assess patients for fever, chills, rigors, nausea, vomiting and hypotension.
Request for blood cultures from the patient, and perform culture and gram-stain of the blood component.
Keep the blood bag and giving set (sealed) for further investigation.
What to do?
Stop transfusion immediately and follow other steps for managing suspected transfusion reactions. Seek urgent medical assistance.
Start broad-spectrum antibiotics once cultures have been taken, including cover for staphylococcal infections.
Provide cardiovascular support.
Treat the specific parasite with antimalarial drugs. Notify the Blood Service.
Malaria infection
When to suspect this adverse reaction?
Patients can present with fever, headache, nausea, vomiting and orthostatic hypotension.
Classic malarial paroxysms depend on the specific infecting Plasmodium species.
This is a rare transfusion-transmitted infection but continues to pose a risk. The estimated residual risk per unit for malaria is 1:4.9 million to 1:10.2 million.(2)
Usual causes?
Malaria is a protozoan disease involving four species of the genus Plasmodium. P falciparum, P vivax, P ovale and P malariae invade red blood cells; and, pose a risk to be transmitted by blood.
In order to minimise this risk, all potential blood donors are subjected to stringent screening procedures, including collection of a comprehensive medical and travel history as part of the donor assessment process.
We perform malarial antibody screening on donors with a potential malarial exposure risk.
Investigation
Clinical assess patients for malaria. Request for thick and thin blood films to demonstrate the asexual forms of the parasite.
Perform other laboratory investigations as necessary.
What to do?
Treat the specific parasite with antimalarial drugs. Notify the Blood Service.
Other infectious disease
There are infectious agents for which there are no routine available tests to predict or prevent the disease from transmission by transfusion. You should look for the features of specific clinical infection.
All potential blood donors are subjected to stringent screening procedures to minimise the risk that they will transmit infectious agents. The incidence varies.
Possible causes may include, but are not limited to, Dengue Fever, West Nile Virus, Chagas Disease and Parvovirus B19.
Investigation
Clinical assessment and microbial investigation.
What to do?
Treat specific diagnosis and notify the Blood Service.
variant Creutzfeldt-Jakob Disease (vCJD)
When to suspect vCJD?
vCJD is a prion disease that affects the central nervous system.
Patients can present with fatigue, weight loss, headache, malaise and deficits in higher cortical function.
There have been no reported cases of vCJD in Australia to date. In the United Kingdom, however, there have been a small number of reported cases of putative transfusion transmission since 2004.
Usual causes?
vCJD is a result of an exposure to tainted beef from cattle with bovine spongiform encephalopathy (BSE). Risk of vCJD is possible but not yet reported in Australia.
There are currently no routine available tests to predict or prevent vCJD from transmission by transfusion. As a precaution, people who have spent a cumulative period of 6 months in the UK between 1 January 1980 and 31 December 1996 and/or had a transfusion in the UK between 1 January 1980 and the present time are not accepted as blood donors in Australia.
Investigation
Clinically assess patients for neurodegenerative signs and symptoms. Immediately consult with experts.
What to do?
Seek expert advice and notify the Blood Service.
Viral infection
Clinical features of different viral infections, such as hepatitis and human immunodeficiency virus (HIV), are variable. Its severity can range from asymptomatic to fatal.
► See residual risk estimates for transfusion-transmitted viral infection
Usual cause?
Transfusion-transmitted viral infections may occur due to window period transmissions.
Investigation
Clinically assess patients for manifestations of specific viral infections.
Perform liver function tests and specific testing for viral markers.
What to do?
Treat the specific diagnosis, if available.
You can reduce the risk of cytomegalovirus (CMV) transmission by requesting for CMV-seronegative or leucocyte-depleted blood components.
References
- Roback JD (ed). AABB Technical Manual 16th edition. AABB Press, Bethesda, 2008.
- Seed CR. Residual Risk Estimates for Transfusion-transmitted Malaria. Australian Red Cross Blood Service DPARC: November 9/10 2005 meeting.
Related topics
Resources
Medilink May 2010 
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