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Bacterial Complications of Transfusion

You are here : Home/ Blood Bank Zone/ Trasfusion Transmitted Diseases/ 11. Bacterial Complications of Transfusion

11. Bacterial Complications of Transfusion

If the venepuncture site is not aseptically cleaned, staphylococi can contaminate the blood unit during collection. Although leucocytes can phagocytose the bacteria during storage; citrate and cold storage also prevent the bacterial overgrowth, the blood unit may still have bacterial overgrowth serious enough to cause septic shock in the recipient.

Bacterial complications of transfusion are rare if closed disposable collection system, sterlite plastic blood bags and collection sets are used. If bacterial complication occurs it can be fatal due to septic shock. Exogenous contaminants are usually introduced either during blood colection, during processing or preparation of components.

These complications occur less frequently with blood components stored at 4�C or - 30�C but platelet concentrates which are maintained at 22�C for their entire shelf-life are more likely to facilitate the bacterial proliferation at room temperature condition. Most of the reported fatal bacterial complication have been from contaminated platelet concentrates. This has led to rethinking in many transfusion centres to decrease the expanded shelf life of platelets from 5 days to 3 days.

If blood components are prepared in closed multiple bag system, the possibility of exogenous contamination is less likely, however, blood collected in open system such as glass bottles and components prepared in open system such as washed cells or filtered blood have a higher risk of getting contaminated and therefore should be processed in sterile environment and have a limited shelf-life of 24 hours.

Infectious agents

The common environmental contaminants that have been reported as causing serious bacterial infections are:

Pseudomonas
Achromobacter
Coliforms (gram-ve organisms even grow at 4�C and RT, not at 37�C)

These bacteria actualy use citrate as the source of energy and lead to clotting of stored blood, which is one of the signs to look for in the blood bag while ruling out bacterial contamination. The gross feature of a contaminated blood unit are:

haemolysis of red cells
clotting of blood
change in colour of red cell (purple/brown)
change in colour of plasma (red)
foul small
fuzzy interface between cells and plasma

Any pinhole leak or break may actually support the possibility of bacterial contamination.

Salmonella and Yersinia enterocolitica (psychrophilie organism even grow at 4�C) are bacteria that may cause low grade or asymptomatic infection in the donor and are endogenous source of contamination. Some bacteria which may not grow at 4�C can grow rapidly in platelet concentrate stored at room temperature.

Fatal salmonella septicaemia has been reported due to transfusion of contaminated platelet concentrates.

Clinical presentation

The reaction to transfusion of contaminated blood develops within few minutes as chills, rigors, fever, nausea, vdmiting, bloody dirrhoea, muscle and abdominal pain, flushing or as septic shock, renal failure, haemoglobinuria, disseminated intravascular coagulation (DIC).

Management

A soon as it is suspected that a contaminated unit has been transfused or when the reaction appears, stop the transfusion and perform following tests:

Recipient�s Blood	Donated unit & collection set
Gram stain	Look for gross sign of contamination
Blood culture at 37�C	Gram stain
4�C	Blood culture at 37�C
22�C	4�C
	22�C
Anaerobic and aerobic bacteria and fungal cultures	Anaerobic & aerobic bacteria & fungal cultures

The patient should be treated with broad-spectum antibiotics and hydrocortisone with adequate fluid replacement.

Prevention of bacterial complications of transfusion

* Collection and transfusion of blood using sterile disposable plastic system
* Aseptic and careful collection of blood
* Correct storage at recommended temperature
* Shortening of platelet shelf-life to 3 days from 5 day of extended storage.
* Quality control of collection procedure
* Blood culture of expired blood units.

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