Transfusion transmitted bacterial infection

When to suspect this adverse reaction?

Clinical features suggesting the possibility of bacterial contamination and/or endotoxin reaction may include rigors, high fever, severe chills, hypotension, tachycardia, nausea and vomiting, dyspnoea, or circulatory collapse during or soon after transfusion.

In severe cases, the patient may develop shock with accompanying renal failure and disseminated intravascular coagulation (DIC) (2). This reaction may be fatal.(1,2)

For clinically apparent reactions, bacterial infections are reported to occur in at least 1:75 000 platelet transfusions and at least 1:500 000 red cell transfusions.(3,4)

Bacterial infection is more common with:

  • platelets (as these are stored at room temperature)
  • previously frozen components thawed by immersion in a water bath
  • red cell components stored for several weeks
     

Usual causes?

Blood components may be contaminated by:(1)

  • Bacteria from the donor’s skin during the collection procedure
  • Unrecognised bacteraemia in the donor
  • Contamination from the environment
  • Contamination during the preparation of components
  • Contamination of ports during the thawing of frozen products in a water bath

Both gram-positive and gram-negative organisms have been implicated in transfusion transmitted bacterial infection with serious morbidity and mortality occurring most frequently with gram-negative bacteria.(1)

Organisms capable of multiplying at low temperatures and those using iron as a nutrient are most often associated with red cell contamination, especially Yersinia enterocolitica.(5)
 

Investigation

Request for blood cultures from the patient, and perform culture and Gram Stain on the remainder of the blood component.

The key to diagnosing transfusion related sepsis is culturing the same organism from the patient and 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 as this may become an emergency.

Start broad-spectrum antibiotics once cultures have been taken.

Provide cardiorespiratory support.

Send blood pack to the Transfusion Service Provider for urgent culture and Gram Stain

Advise Transfusion Service Provider to notify the Blood Service to ensure quarantining and testing of related components from the same donation/donor.
 

References
  1. Callum JL, Pinkerton PH, Lima A, Lin Y, Karkouti K, Lieberman, L, et al. Chapter 5, Transfusion Reactions. Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 4rd edition. Canada: Ontario Regional Blood Coordinating Network, 2016.
  2.  Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 18th edition. AABB, Bethesda, 2014.
  3. Eder A et al. Bacterial screening of apheresis platelets and the residual risk of septic transfusion reactions: the American Red Cross experience (2004–2006). Transfusion 2007;47:1134–1142.
  4. Kuehnert MJ et al. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion 2001;41:1493–1499.
  5. Guinet F, Carniel E, Leclercq A.  Transfusion-Transmitted Yersinia enterocolitica sepsis.  Clin Infect Dis 2011;53(6):583-591.