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Bloch EM, Marshall CE, Boyd JS, Shifflett L, Tobian AA, Gehrie EA, Ness PM. Implementation of secondary bacterial culture testing of platelets to mitigate residual risk of septic transfusion reactions. Transfusion 2018; 58:1647-1653. [DOI: 10.1111/trf.14618] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Evan M. Bloch
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Christi E. Marshall
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Joan S. Boyd
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Lisa Shifflett
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Aaron A.R. Tobian
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Eric A. Gehrie
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Paul M. Ness
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
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52
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Corean J, Al-Tigar R, Pysher T, Blaylock R, Metcalf RA. Quality Improvement After Multiple Fatal Transfusion-Transmitted Bacterial Infections. Am J Clin Pathol 2018; 149:293-299. [PMID: 29462235 DOI: 10.1093/ajcp/aqx167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Transfusion-transmitted bacterial infection (TTBI) from platelet components is likely underrecognized and can be fatal. Twenty-four-hour prospective culture was felt to be insufficiently preventive after multiple TTBIs occurred and strategies to improve safety were sought. METHODS Two fatal and one severe TTBIs occurred from a split-apheresis platelet donation contaminated with Klebsiella pneumoniae. Improvement opportunities were identified and corrective and preventive action (CAPA) followed. RESULTS To mitigate bacterial contamination and improve detection sensitivity, additional prospective culture 48 hours postcollection was implemented. Since implementation, secondary cultures have caught two true positives (0.01%) missed by 24-hour culture. Bacterial testing at issue and pathogen reduction were later implemented as an added layer of safety. CONCLUSION While rare, TTBI is a prominent cause of morbidity and mortality from contaminated platelets. The approach to CAPA presented here may lower the risk of future transfusion-transmitted infections but must be weighed against potential added costs.
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Affiliation(s)
- Jessica Corean
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
- ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City
| | - Rami Al-Tigar
- ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City
| | - Theodore Pysher
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
- Department of Pediatric Pathology, Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Robert Blaylock
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
- ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City
| | - Ryan A Metcalf
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
- ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City
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53
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Hadjesfandiari N, Weinhart M, Kizhakkedathu JN, Haag R, Brooks DE. Development of Antifouling and Bactericidal Coatings for Platelet Storage Bags Using Dopamine Chemistry. Adv Healthc Mater 2018; 7. [PMID: 28961393 DOI: 10.1002/adhm.201700839] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/10/2022]
Abstract
Platelets have a limited shelf life, due to the risk of bacterial contamination and platelet quality loss. Most platelet storage bags are made of a mixture of polyvinyl chloride with a plasticizer, denoted as pPVC. To improve biocompatibility of pPVC with platelets and to inhibit bacterial biofilm formation, an antifouling polymer coating is developed using mussel-inspired chemistry. A copolymer of N,N-dimethylacrylamide and N-(3-aminopropyl)methacrylamide hydrochloride is synthesized and coupled with catechol groups, named DA51-cat. Under mild aqueous conditions, pPVC is first equilibrated with an anchoring polydopamine layer, followed by a DA51-cat layer. Measurements show this coating decreases fibrinogen adsorption to 5% of the control surfaces. One-step coating with DA51-cat does not coat pPVC efficiently although it is sufficient for coating silicon wafers and gold substrates. The dual layer coating on platelet bags resists bacterial biofilm formation and considerably decreases platelet adhesion. A cationic antimicrobial peptide, E6, is conjugated to DA51-cat then coated on silicon wafers and introduces bactericidal activity to these surfaces. Time-of-flight second ion-mass spectroscopy is successfully applied to characterize these surfaces. pPVC is widely used in medical devices; this method provides an approach to controlling biofouling and bacterial growth on it without elaborate surface modification procedures.
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Affiliation(s)
- Narges Hadjesfandiari
- Center for Blood Research; University of British Columbia; 2350 Health Sciences Mall Vancouver V6T 1Z3 Canada
- Department of Chemistry; University of British Columbia; Vancouver V6T 1Z1 Canada
| | - Marie Weinhart
- Institute of Chemistry and Biochemistry; Freie Universität Berlin; Takustrasse 3 14195 Berlin Germany
| | - Jayachandran N. Kizhakkedathu
- Center for Blood Research; University of British Columbia; 2350 Health Sciences Mall Vancouver V6T 1Z3 Canada
- Department of Chemistry; University of British Columbia; Vancouver V6T 1Z1 Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver V6T 2B5 Canada
| | - Rainer Haag
- Institute of Chemistry and Biochemistry; Freie Universität Berlin; Takustrasse 3 14195 Berlin Germany
| | - Donald E. Brooks
- Center for Blood Research; University of British Columbia; 2350 Health Sciences Mall Vancouver V6T 1Z3 Canada
- Department of Chemistry; University of British Columbia; Vancouver V6T 1Z1 Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver V6T 2B5 Canada
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54
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Chetouane Y, Dubourg G, Gallian P, Flaudrops C, Chiaroni J, Chabrière E, Raoult D, Camoin-Jau L. Rapid identification of microorganisms from platelet concentrates by matrix-assisted laser desorption ionization time-of-flight mass spectrometry after short-term incubation on liquid medium. Transfusion 2017; 58:766-773. [PMID: 29193200 DOI: 10.1111/trf.14430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Platelets (PLTs) are especially affected by the risk of bacterial contamination. Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) is an accurate method for the routine identification of bacterial isolates in microbiology laboratories. We directly applied the MALDI-TOF method to bacterial detection in PLTs. In this study, we evaluated the sensitivity, specificity, and speed of a direct MALDI-TOF approach compared to the conventional method BACTEC. STUDY DESIGN AND METHODS Eight bacteria associated with PLT contamination, cited by the ISBT on transfusion-transmitted infectious diseases, were spiked into PLTs for a final concentration of approximately 100 CFU/bag (n = 5 for each strain). The PLTs were then agitated for 24 hours. One milliliter of PLTs was incubated in a shaker incubator for 8 hours at 37°C with 1 mL of trypticase soy broth (TSB). The spectra were analyzed using the MALDI Biotyper software. As a control, 8 mL of PLTs incubated into BACTEC bottles and a positive bottle were subcultured to ensure identification of bacterial growth. RESULTS Regardless of the strain of PLTs tested, MALDI-TOF analysis made detection and early identification possible at 8 hours. Analysis by BACTEC of PLTs infected with Escherichia coli, Bacillus cereus, and Providencia stuartii made early identification possible. For the remaining bacteria, the detection time by BACTEC was significantly longer than 8 hours. CONCLUSION We demonstrated the possibility of detecting bacteria in PLTs using a standardized culture step in TSB with MALDI-TOF, regardless of the strain, with the same specificity and analytical sensitivity and with a time to results of 12 hours. This direct method presented rapid and reliable results.
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Affiliation(s)
- Yasmine Chetouane
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Gregory Dubourg
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre Gallian
- IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Etablissement Français du Sang (EFS), La Plaine Saint-Denis, France
| | - Christophe Flaudrops
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jacques Chiaroni
- Etablissement Français du Sang Alpes Méditerranée and Aix-Marseille Université, CNRS, EFS Biologie des Groupes Sanguins, ADES UMR 7268, Marseille, France
| | - Eric Chabrière
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Laurence Camoin-Jau
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Assistance Publique Hôpitaux de Marseille, Laboratoire d'Hématologie, CHU Timone, Marseille, France
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55
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Kreuger AL, Rostgaard K, Middelburg RA, Kerkhoffs JLH, Edgren G, Erikstrup C, Pedersen OB, Titlestad K, Nielsen KR, Ostrowski SR, Voldstedlund M, van der Bom JG, Ullum H, Hjalgrim H. Storage time of platelet concentrates and risk of a positive blood culture: a nationwide cohort study. Transfusion 2017; 58:16-24. [PMID: 29168187 DOI: 10.1111/trf.14401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Concern of transfusion-transmitted bacterial infections has been the major hurdle to extend shelf life of platelet (PLT) concentrates. We aimed to investigate the association between storage time and risk of positive blood cultures at different times after transfusion. STUDY DESIGN AND METHODS We performed a nationwide cohort study among PLT transfusion recipients in Denmark between 2010 and 2012, as recorded in the Scandinavian Donations and Transfusions (SCANDAT2) database. Linking with a nationwide database on blood cultures (MiBa), we compared the incidence of a positive blood culture among recipients of PLTs stored 6 to 7 days (old) to those receiving fresh PLTs (1-5 days), using Poisson regression models. We considered cumulative exposures in windows of 1, 3, 5, and 7 days. RESULTS A total of 9776 patients received 66,101 PLT transfusions. The incidence rate ratio (IRR) of a positive blood culture the day after transfusion of at least one old PLT concentrate was 0.77 (95% confidence interval [CI], 0.54-1.09) compared to transfusion of fresh PLT concentrates. The incidence rate of a positive blood culture was lower the day after receiving one old compared to one fresh PLT concentrate (IRR, 0.57; 95% CI, 0.37-0.87). Three, 5, or 7 days after transfusion, storage time was not associated with the risk of a positive blood culture. CONCLUSION Storage of buffy coat-derived PLT concentrates in PAS-C up to 7 days seems safe regarding the risk of a positive blood culture. If anything, transfusion of a single old PLT concentrate may decrease this risk the following day.
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Affiliation(s)
- Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Louis H Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Haga Hospital, Den Haag, the Netherlands
| | - Gustav Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Johnson P, Moriwaki M, Johnson J. Rapid, sensitive detection of bacteria in platelet samples with Fountain Flow Cytometry. J Clin Lab Anal 2017; 31:e22115. [PMID: 28177537 PMCID: PMC6817245 DOI: 10.1002/jcla.22115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/21/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is a current need to develop a technique for bacterial screening of platelet donations that is more rapid, sensitive, and economical than alternatives. The objective of this research was to perform a pilot test of the viability of Fountain Flow Cytometry (FFC), for the rapid and sensitive detection of bacteria in platelet donations. METHODS Platelet samples were inoculated with serial dilutions of five selected bacterial strains. Samples were then centrifuged, reconstituted in buffer, and stained with a live/dead bacterial stain cocktail. The resulting aqueous sample was measured by FFC, in which the sample passed as a stream in front of an LED, which excited the fluorescent labels. Fluorescence was detected with a digital camera as the sample flowed toward it. RESULTS Fountain Flow Cytometry enumeration yielded results that were linear with bacterial concentration, having an R2 of ≥0.98 with a detection efficiency of 92%±3%. Measurements of uninoculated samples showed a false-positive detection rate at ~400 colony forming units (CFU)/mL. Detection of bacterial concentrations in platelets above this threshold can be made in ~15 minutes, including sample preparation time. CONCLUSION This pilot study supports the efficacy of FFC for the rapid and sensitive screening of platelet donations for bacteria.
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Affiliation(s)
- Paul Johnson
- Department of Physics and AstronomyUniversity of WyomingLaramieWYUSA
- SoftRay IncLaramieWYUSA
| | - Mika Moriwaki
- Molecular Medicine ProgramUniversity of UtahSalt Lake CityUTUSA
| | - Joseph Johnson
- College of Osteopathic Medicine of the PacificWestern University of Health SciencesPomonaCAUSA
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57
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Bloch EM. Residual risk of bacterial contamination: what are the options? Transfusion 2017; 57:2289-2292. [DOI: 10.1111/trf.14306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Evan M. Bloch
- Department of PathologyJohns Hopkins University, School of MedicineBaltimore MD
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Estcourt LJ, Malouf R, Hopewell S, Trivella M, Doree C, Stanworth SJ, Murphy MF. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database Syst Rev 2017; 7:CD009072. [PMID: 28756627 PMCID: PMC5558872 DOI: 10.1002/14651858.cd009072.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Platelet transfusions are used to prevent and treat bleeding in people who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial, or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce the risk of blood transfusion-transmitted infections from platelet transfusion is photochemical pathogen reduction, in which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet count recovery and the prevention of bleeding when compared with standard platelets.This is an update of a Cochrane review first published in 2013. OBJECTIVES To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in people of any age requiring platelet transfusions. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 24 October 2016. SELECTION CRITERIA We included RCTs comparing the transfusion of pathogen-reduced platelets with standard platelets, or comparing different types of pathogen-reduced platelets. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified five new trials in this update of the review. A total of 15 trials were eligible for inclusion in this review, 12 completed trials (2075 participants) and three ongoing trials. Ten of the 12 completed trials were included in the original review. We did not identify any RCTs comparing the transfusion of one type of pathogen-reduced platelets with another.Nine trials compared Intercept® pathogen-reduced platelets to standard platelets, two trials compared Mirasol® pathogen-reduced platelets to standard platelets; and one trial compared both pathogen-reduced platelets types to standard platelets. Three RCTs were randomised cross-over trials, and nine were parallel-group trials. Of the 2075 participants enrolled in the trials, 1981 participants received at least one platelet transfusion (1662 participants in Intercept® platelet trials and 319 in Mirasol® platelet trials).One trial included children requiring cardiac surgery (16 participants) or adults requiring a liver transplant (28 participants). All of the other participants were thrombocytopenic individuals who had a haematological or oncological diagnosis. Eight trials included only adults.Four of the included studies were at low risk of bias in every domain, while the remaining eight included studies had some threats to validity.Overall, the quality of the evidence was low to high across different outcomes according to GRADE methodology.We are very uncertain as to whether pathogen-reduced platelets increase the risk of any bleeding (World Health Organization (WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio (RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I2 = 59%, random-effect RR 1.14, 95% CI 0.93 to 1.38; I2 = 59%; low-quality evidence).There was no evidence of a difference between pathogen-reduced platelets and standard platelets in the incidence of clinically significant bleeding complications (WHO Grade 2 or higher) (5 trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I2 = 0%; moderate-quality evidence), and there is probably no difference in the risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495 participants; RR 1.24, 95% CI 0.76 to 2.02; I2 = 32%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR 0.81, 95% CI 0.50 to 1.29; I2 = 26%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of serious adverse events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35; I2 = 0%; moderate-quality evidence). However, no bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Participants who received pathogen-reduced platelet transfusions had an increased risk of developing platelet refractoriness (7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I2 = 0%; high-quality evidence), though the definition of platelet refractoriness differed between trials.Participants who received pathogen-reduced platelet transfusions required more platelet transfusions (6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to 1.61; I2 = 27%; high-quality evidence), and there was probably a shorter time interval between transfusions (6 trials, 1489 participants; MD -0.42, 95% CI -0.53 to -0.32; I2 = 29%; moderate-quality evidence). Participants who received pathogen-reduced platelet transfusions had a lower 24-hour corrected-count increment (7 trials, 1681 participants; MD -3.02, 95% CI -3.57 to -2.48; I2 = 15%; high-quality evidence).None of the studies reported quality of life.We did not evaluate any economic outcomes.There was evidence of subgroup differences in multiple transfusion trials between the two pathogen-reduced platelet technologies assessed in this review (Intercept® and Mirasol®) for all-cause mortality and the interval between platelet transfusions (favouring Intercept®). AUTHORS' CONCLUSIONS Findings from this review were based on 12 trials, and of the 1981 participants who received a platelet transfusion only 44 did not have a haematological or oncological diagnosis.In people with haematological or oncological disorders who are thrombocytopenic due to their disease or its treatment, we found high-quality evidence that pathogen-reduced platelet transfusions increase the risk of platelet refractoriness and the platelet transfusion requirement. We found moderate-quality evidence that pathogen-reduced platelet transfusions do not affect all-cause mortality, the risk of clinically significant or severe bleeding, or the risk of a serious adverse event. There was insufficient evidence for people with other diagnoses.All three ongoing trials are in adults (planned recruitment 1375 participants) with a haematological or oncological diagnosis.
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Affiliation(s)
- Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNHS Blood and Transplant; National Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe HospitalHeadingtonOxfordUK
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Poon MC, Di Minno G, Zotz R, d’Oiron R. Glanzmann’s thrombasthenia: strategies for identification and management. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1341306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Man-Chiu Poon
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Center for Coagulation Disorders, Federico II University, Naples, Italy
| | - Rainer Zotz
- Institute for Laboratory Medicine, Blood Coagulation and Transfusion Medicine (LBT), Düsseldorf, Germany
- Department of Haemostasis, Haemotherapy and Transfusion Medicine, Heinrich Heine University Medical Centre, D-40225 Düsseldorf, Germany
| | - Roseline d’Oiron
- Centre for Haemophilia and Rare Congenital Bleeding Disorders, University Hospitals Paris-Sud, Le Kremlin-Bicêtre, France
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60
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Ramirez-Arcos S, DiFranco C, McIntyre T, Goldman M. Residual risk of bacterial contamination of platelets: six years of experience with sterility testing. Transfusion 2017; 57:2174-2181. [DOI: 10.1111/trf.14202] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/04/2017] [Accepted: 04/30/2017] [Indexed: 01/29/2023]
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McDonald C, Allen J, Brailsford S, Roy A, Ball J, Moule R, Vasconcelos M, Morrison R, Pitt T. Bacterial screening of platelet components by National Health Service Blood and Transplant, an effective risk reduction measure. Transfusion 2017; 57:1122-1131. [PMID: 28425610 DOI: 10.1111/trf.14085] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bacterial contamination of blood components remains a major cause of sepsis in transfusion medicine. Between 2006 and 2010 in the 5 years before the introduction of bacterial screening of platelet (PLT) components by National Health Service Blood and Transplant (NHSBT), seven cases of PLT component-associated transmission of bacterial infection were recorded for 10 patients, three of which were fatal. STUDY DESIGN AND METHODS Sampling of individual PLT components was undertaken at 36 to 48 hours after donation and tested in the BacT/ALERT system with 8 mL inoculated into each of aerobic and anaerobic culture bottles. Bottles were incubated until the end of the 7-day shelf life and initial reactive bottles were examined for contamination. Bacterial screened time-expired PLTs were tested as in the screen method. RESULTS From February 2011 to September 2015, a total of 1,239,029 PLT components were screened. Initial-reactive, confirmed-positive, and false-positive rates were 0.37, 0.03, and 0.19%, respectively. False-negative cultures, all with Staphylococcus aureus, occurred on four occasions; three were visually detected before transfusion and one confirmed transmission resulted in patient morbidity. The NHSBT screening protocol effectively reduced the number of clinically adverse transfusion transmissions by 90% in this reporting period, compared to a similar time period before implementation. Delayed testing of 4515 time-expired PLT units after screening revealed no positives. CONCLUSION The implementation of bacterial screening of PLT components with the NHSBT BacT/ALERT protocol was an effective risk reduction measure and increased the safety of the blood supply.
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62
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Loza-Correa M, Kou Y, Taha M, Kalab M, Ronholm J, Schlievert PM, Cahill MP, Skeate R, Cserti-Gazdewich C, Ramirez-Arcos S. Septic transfusion case caused by a platelet pool with visible clotting due to contamination withStaphylococcus aureus. Transfusion 2017; 57:1299-1303. [DOI: 10.1111/trf.14049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - Michael P. Cahill
- Department of Microbiology; Carver College of Medicine; Iowa City Iowa
| | - Robert Skeate
- Department of Microbiology; Carver College of Medicine; Iowa City Iowa
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63
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Ramirez-Arcos S, Kou Y, Ducas É, Thibault L. Changing the 30-min Rule in Canada: The Effect of Room Temperature on Bacterial Growth in Red Blood Cells. Transfus Med Hemother 2016; 43:396-399. [PMID: 27994525 DOI: 10.1159/000445753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To maintain product quality and safety, the '30-min rule' requires the discard of red blood cells (RBCs) that are exposed to uncontrolled temperatures for more than 30 min. Recent studies suggest this rule may safely be extended to a 60-min rule. METHODS A pool-and-split design study (N = 4) was run in parallel at Canadian Blood Services (SAGM RBCs) and Héma-Québec (AS-3 RBCs). RBCs were spiked with ∼1 colony-forming unit/ml of mesophilic and psychrophilic bacteria. Control units remained in storage at 1-6 °C for 42 days. Test 30 (T30) and T60 units were exposed to room temperature (RT) six times during storage, each time for 30 and 60 min, respectively. Bacterial proliferation was monitored. RESULTS Mesophilic bacteria do not proliferate in RBCs. The growth of psychrophilic bacteria is not significantly different in RBCs exposed for 30 or 60 min to RT (p < 0.05). CONCLUSION The study findings were the final evidence to support extension from a 30-min rule to a 60-min rule in Canada.
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Affiliation(s)
| | - Yuntong Kou
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - Éric Ducas
- Héma-Québec, Research and Development, Operational Research, Québec, QC, Canada
| | - Louis Thibault
- Héma-Québec, Research and Development, Operational Research, Québec, QC, Canada
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64
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Complications of Transfusion. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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65
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Hadjesfandiari N, Schubert P, Fallah Toosi S, Chen Z, Culibrk B, Ramirez-Arcos S, Devine DV, Brooks DE. Effect of texture of platelet bags on bacterial and platelet adhesion. Transfusion 2016; 56:2808-2818. [DOI: 10.1111/trf.13756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/29/2016] [Accepted: 07/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Narges Hadjesfandiari
- Department of Chemistry; Canadian Blood Services; Vancouver British Columbia
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
| | - Peter Schubert
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia
| | - Salma Fallah Toosi
- Department of Chemical and Biological Engineering; University of British Columbia; Vancouver Canada
| | - Zhongming Chen
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
| | - Brankica Culibrk
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
| | | | - Dana V. Devine
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia
| | - Donald E. Brooks
- Department of Chemistry; Canadian Blood Services; Vancouver British Columbia
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia
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66
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Hume HA, Ddungu H, Angom R, Baluku H, Kajumbula H, Kyeyune-Byabazaire D, Orem J, Ramirez-Arcos S, Tobian AA. Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions. Transfusion 2016; 56:1951-9. [PMID: 27079627 PMCID: PMC5518785 DOI: 10.1111/trf.13594] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/20/2016] [Accepted: 02/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA). STUDY DESIGN AND METHODS This prospective, observational study evaluated the rate of BC in whole blood-derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions. RESULTS In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3% to 2.1% (according to criteria used to define BC). The Gram stain had high specificity (99.1%) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78% of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3% (95% confidence interval, 3.7%-12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. CONCLUSIONS The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.
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Affiliation(s)
- Heather A. Hume
- CHU Ste Justine, University of Montreal, Montreal, QC, Canada
| | | | | | | | - Henry Kajumbula
- College of Health Sciences, Makerere University, Kampala, Uganda
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67
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Abstract
Platelet transfusions continue to be the mainstay to treat patients with quantitative and qualitative platelet disorders. Each year, about 10 millions of platelet transfusions are administered to patients worldwide with marked differences in usage between regions depending on socioeconomic development of the countries. Unfortunately, its use is associated to immune and non-immune side effects. Among the non-immune, bacterial contamination is still the major infectious risk. When bacterial culture methods are introduced for preventing bacterial septic reactions it has been found that this strategy reduce to one half the septic reactions, but do not eliminate completely that risk. To remove completely the risk, a new bacteria detection test at the time of issuance in the case of platelets stored for four or five days would be needed. Pathogen inactivation (PI) methods already in the market (based in the addition of amotosalen (A-L) or riboflavin (R-L) and the illumination with ultraviolet light) or under development (ultraviolet light C and agitation) have shown to be efficacious in the inactivation of bacteria and no cases of septic reactions associated to a pathogen-reduced product has been identified. However, it has been shown that PI technologies have measurable effects on platelet in vitro parameters and reduce the recovery and survival of treated platelets in vivo. Although these effects do not hamper the hemostatic capacity of treated platelets, an increased usage associated with PI technologies has been reported. This increase in utilization seems to be the toll to be paid if we want to completely eliminate the risk of bacterial sepsis in the recipients of platelet transfusion.
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68
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Taha M, Kalab M, Yi QL, Maurer E, Jenkins C, Schubert P, Ramirez-Arcos S. Bacterial survival and distribution during buffy coat platelet production. Vox Sang 2016; 111:333-340. [PMID: 27432557 DOI: 10.1111/vox.12427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/09/2016] [Accepted: 06/03/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES At Canadian Blood Services, buffy coat (BC) platelet concentrates (BC-PCs) show a generally lower bacterial contamination rate than apheresis PCs. This study investigated whether the PC production method contributes to this observation. MATERIALS AND METHODS Whole blood (WB) inoculated with eight bacterial strains was processed using the BC method. Bacteria were enumerated throughout BC-PC production and subsequent PC storage. Endotoxin production and bacterial adhesion to PC bags were evaluated during PC storage. PC quality was monitored by CD62P expression (flow cytometry) and changes in dynamic light scattering (ThromboLUX® ). RESULTS During overnight WB hold, Staphylococcus epidermidis titres remained unchanged, commercial Escherichia coli and Klebsiella pneumoniae were eliminated and the remaining organisms proliferated to high concentrations. Through BC-PC production, bacteria segregated preferentially towards the cellular fractions compared to plasma (P < 0·05). During PC storage, most bacteria adhered to the PC bags and Gram negatives produced clinically significant endotoxin levels. Changes in CD62P expression or ThromboLUX scoring did not consistently reflect bacterial contamination in BC-PCs. CONCLUSION WB hold during BC-PC production does not have a broad-spectrum bactericidal effect, and therefore, other factors contribute to low rates of contamination in BC-PCs.
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Affiliation(s)
- M Taha
- Canadian Blood Services, Ottawa, ON, Canada
| | - M Kalab
- Agriculture and Agri-Food Canada, Ottawa, ON, Canada
| | - Q-L Yi
- Canadian Blood Services, Ottawa, ON, Canada
| | - E Maurer
- LightIntegra, Vancouver, BC, Canada
| | - C Jenkins
- Canadian Blood Services, Ottawa, ON, Canada
| | - P Schubert
- Canadian Blood Services, Ottawa, ON, Canada
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69
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Seheult JN, Triulzi D, Yazer MH. I am the 9%: Making the case for whole-blood platelets. Transfus Med 2016; 26:177-85. [DOI: 10.1111/tme.12312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J. N. Seheult
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - D.J. Triulzi
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh PA USA
- The Institute for Transfusion Medicine; Pittsburgh PA USA
| | - M. H. Yazer
- Department of Pathology; University of Pittsburgh School of Medicine; Pittsburgh PA USA
- The Institute for Transfusion Medicine; Pittsburgh PA USA
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70
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Loza-Correa M, Perkins H, Kumaran D, Kou Y, Qaisar R, Geelhood S, Ramirez-Arcos S. Noninvasive pH monitoring for bacterial detection in platelet concentrates. Transfusion 2016; 56:1348-55. [PMID: 27028108 DOI: 10.1111/trf.13557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/20/2016] [Accepted: 01/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bacterial contamination of platelet concentrates (PCs) remains the prevalent posttransfusion infectious risk. The pH SAFE system, a noninvasive method used to measure pH of PC for quality control, was evaluated herein as a rapid method to detect bacterial contamination in PCs. STUDY DESIGN AND METHODS Pairs of ABO-D-matched apheresis and buffy coat PCs were pooled and split into two pH SAFE platelet bags. One of the bags served as the control unit, while the other was inoculated with one of nine clinically relevant bacteria (target concentration approx. 1 colony-forming units [CFUs]/mL). The pH of both PCs was measured over 7 days of storage at approximately 4-hour intervals during daytime. One-milliliter samples were taken at the testing points to determine bacterial concentration. RESULTS PCs with pH values of less than 6.6 or with a pH change over time (ΔpH/Δtime) greater or equal than 0.046 pH units/hr are suspected of being contaminated. pH decreased significantly during storage in all bacterially inoculated PC at concentrations of more than 10(7) CFUs/mL (p < 0.0001). A significant decrease in pH (p < 0.0001) was noticed as early as 28 hours in units with Bacillus cereus and as late as 125 hours in units containing Staphylococcus epidermidis. Interestingly, PCs containing Gram-negative species showed a decline in pH followed by a rebound. CONCLUSIONS The pH SAFE system allows for repeated, noninvasive pH screening during PC storage. A significant decrease in pH could serve as an indicator of clinically significant levels of bacterial contamination. Since differences in pH decline were observed among bacterial species, continuous pH monitoring in PCs is recommended.
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Affiliation(s)
| | | | | | - Yuntong Kou
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Ramie Qaisar
- Canadian Blood Services, Ottawa, Ontario, Canada
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71
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New Insights Into the Treatment of Glanzmann Thrombasthenia. Transfus Med Rev 2016; 30:92-9. [PMID: 26968829 DOI: 10.1016/j.tmrv.2016.01.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 11/21/2022]
Abstract
Glanzmann thrombasthenia (GT) is a rare inherited autosomal recessive bleeding disorder of platelet function caused by a quantitative or qualitative defect of platelet membrane glycoprotein IIb/IIIa (integrin αIIbβ3), a fibrinogen receptor required for platelet aggregation. Bleeds in GT are variable and may be severe and unpredictable. Bleeding not responsive to local and adjunctive measures, as well as surgical procedures, is treated with platelets, recombinant activated factor VII (rFVIIa), or antifibrinolytics, alone or in combination. Although platelets are the standard treatment for GT, their use is associated with the risk of blood-borne infection transmission and may also cause the development of platelet antibodies (to human leukocyte antigens and/or αIIbβ3), potentially resulting in platelet refractoriness. Currently, where rFVIIa is approved for use in GT, this is mostly for patients with platelet antibodies and/or a history of platelet refractoriness. However, data from the prospective Glanzmann's Thrombasthenia Registry (829 bleeds and 206 procedures in 218 GT patients) show that rFVIIa was frequently used in nonsurgical and surgical bleeds, with high efficacy rates, irrespective of platelet antibodies/refractoriness status. The mechanisms underpinning rFVIIa effectiveness in GT have been studied. At therapeutic concentrations, rFVIIa binds to activated platelets and directly activates FX to FXa, resulting in a burst of thrombin generation. Thrombin converts fibrinogen to fibrin and also enhances GT platelet adhesion and aggregation mediated by the newly converted (polymeric) fibrin, leading to primary hemostasis at the wound site. In addition, thrombin improves the final clot structure and activates thrombin-activatable fibrinolysis inhibitor to decrease clot lysis.
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72
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Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance. Blood 2016; 127:496-502. [DOI: 10.1182/blood-2015-07-655944] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/17/2015] [Indexed: 11/20/2022] Open
Abstract
Key Points
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.
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73
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Benjamin RJ, Wagner SJ. Bacterial pathogen reduction requires validation under conditions of intended use. Transfusion 2015; 55:2060-3. [DOI: 10.1111/trf.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/29/2022]
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74
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Kleinman S, Stassinopoulos A. Risks associated with red blood cell transfusions: potential benefits from application of pathogen inactivation. Transfusion 2015; 55:2983-3000. [PMID: 26303806 PMCID: PMC7169855 DOI: 10.1111/trf.13259] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/02/2015] [Accepted: 06/22/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion risks could be reduced if a robust technology for pathogen inactivation of RBC (PI-RBCs) were to be approved. MATERIALS AND METHODS Estimates of per-unit and per-patient aggregate infectious risks for conventional RBCs were calculated; the latter used patient diagnosis as a determinant of estimated lifetime exposure to RBC units. Existing in vitro data for the two technologies under development for producing PI-RBCs and the status of current clinical trials are reviewed. RESULTS Minimum and maximum per-unit risk were calculated as 0.0003% (1 in 323,000) and 0.12% (1 in 831), respectively. The minimum estimate is for known lower-risk pathogens while the maximal estimate also includes an emerging infectious agent (EIA) and endemic area Babesia risk. Minimum and maximum per-patient lifetime risks by diagnosis grouping were estimated as 1.5 and 3.3%, respectively, for stem cell transplantation (which includes additional risk for cytomegalovirus transmission); 1.2 and 3.7%, respectively, for myelodysplastic syndrome; and 0.2 and 44%, respectively, for hemoglobinopathy. DISCUSSION There is potential for PI technologies to reduce infectious RBC risk and to provide additional benefits (e.g., prevention of transfusion-associated graft-versus-host disease and possible reduction of alloimmunization) due to white blood cell inactivation. PI-RBCs should be viewed in the context of having a fully PI-treated blood supply, enabling a blood safety paradigm shift from reactive to proactive. Providing insurance against new EIAs. Further, when approved, the use of PI for all components may catalyze operational changes in blood donor screening, laboratory testing, and component manufacturing.
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Affiliation(s)
- Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
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75
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Chew E, Benjamin RJ, McDonald CP, Wiersum-Osselton JC, Wood EM. International survey on definitions and current practices in prevention, diagnosis, management and reporting of transfusion-transmitted bacterial infections. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/voxs.12176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Chew
- Department of Diagnostic Haematology; The Royal Melbourne Hospital; Grattan Street Parkville Vic. Australia
| | - R. J. Benjamin
- American Red Cross Biomedical Services; Rockville MD USA
| | | | | | - E. M. Wood
- Transfusion Research Unit; Monash Medical Centre; Monash University; Melbourne Vic. Australia
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76
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Schmidt M, Hourfar MK, Sireis W, Pfeiffer U, Göttig S, Kempf VA, McDonald CP, Seifried E. Evaluation of the effectiveness of a pathogen inactivation technology against clinically relevant transfusion-transmitted bacterial strains. Transfusion 2015; 55:2104-12. [DOI: 10.1111/trf.13171] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Michael Schmidt
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Michael K. Hourfar
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Walid Sireis
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Ulrich Pfeiffer
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Stephan Göttig
- Institute for Medical Microbiology and Infection Control; Hospital of Goethe-University; Frankfurt am Main Germany
| | - Volkhard A.J. Kempf
- Institute for Medical Microbiology and Infection Control; Hospital of Goethe-University; Frankfurt am Main Germany
| | - Carl P. McDonald
- National Bacteriology Laboratory; NHS Blood and Transplant; Colindale London UK
| | - Erhard Seifried
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
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77
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Kou Y, Pagotto F, Hannach B, Ramirez-Arcos S. Fatal false-negative transfusion infection involving a buffy coat platelet pool contaminated with biofilm-positiveStaphylococcus epidermidis: a case report. Transfusion 2015; 55:2384-9. [DOI: 10.1111/trf.13154] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/04/2015] [Accepted: 04/08/2015] [Indexed: 12/01/2022]
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78
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Tokuno O, Hayakawa A, Yanai T, Mori T, Ohnuma K, Tani A, Minami H, Sugimoto T. Sterility Testing of Stem Cell Products by Broad-Range Bacterial 16S Ribosomal DNA Polymerase Chain Reaction. Lab Med 2015; 46:34-41. [DOI: 10.1309/lmkt4p9ffi2bbsiu] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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79
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Müller B, Walther-Wenke G, Kalus M, Alt T, Bux J, Zeiler T, Schottstedt V. Routine bacterial screening of platelet concentrates by flow cytometry and its impact on product safety and supply. Vox Sang 2014; 108:209-18. [PMID: 25469957 DOI: 10.1111/vox.12214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/29/2014] [Accepted: 09/29/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Bacterial contamination represents the major infectious hazard associated with transfusion of platelet concentrates (PCs). As bacterial screening of PCs is not mandatory in Germany, the BactiFlow flow cytometry test has been introduced as a rapid detection method to increase product safety. MATERIALS AND METHODS During a period of 25 months, a total of 34 631 PCs (26 411 pooled and 8220 apheresis-derived PCs) were tested at the end of day 3 of their shelf life using the BactiFlow system. PCs initially reactive in BactiFlow testing and expired PCs not reactive in BactiFlow on day 3 were also investigated by the BacT/ALERT system and by microbiological cultivation in order to identify the contaminating bacterial species and to confirm reactive BactiFlow results. RESULTS Two hundred and twenty-eight PCs (0.7%) had an initially reactive result, 24 of them remained reactive in a second test run. Out of these reproducible reactive BactiFlow results, 12 could not be verified by parallel BacT/ALERT culturing, resulting in a confirmed false-positive rate of 0.03%. The bacterial species were identified as S. aureus, S. epidermidis, S. dysgalactiae ssp. equisimilis and B. cereus. In 10 out of 9017 expired PCs (0.11%), a confirmed-positive result was obtained in the BacT/ALERT system which had a negative result in the BactiFlow system. CONCLUSION Testing of PCs by BactiFlow was successfully implemented in our blood donation service and proved sufficient as a rapid and reliable screening method. False reactive results are in an acceptable range since the transfusion of 12 bacterially contaminated PCs was prevented.
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Affiliation(s)
- B Müller
- GRC-West Blood Donation Service, Central Laboratory Hagen, Hagen, Germany
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80
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Klausen SS, Hervig T, Seghatchian J, Reikvam H. Bacterial contamination of blood components: Norwegian strategies in identifying donors with higher risk of inducing septic transfusion reactions in recipients. Transfus Apher Sci 2014; 51:97-102. [DOI: 10.1016/j.transci.2014.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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81
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Lafeuillade B, Eb F, Ounnoughene N, Petermann R, Daurat G, Huyghe G, Vo Mai MP, Caldani C, Rebibo D, Weinbreck P. Residual risk and retrospective analysis of transfusion-transmitted bacterial infection reported by the French National Hemovigilance Network from 2000 to 2008. Transfusion 2014; 55:636-46. [DOI: 10.1111/trf.12883] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Bruno Lafeuillade
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - François Eb
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Nadra Ounnoughene
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Rachel Petermann
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Gérald Daurat
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Gérard Huyghe
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Mai-Phuong Vo Mai
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Cyril Caldani
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Danielle Rebibo
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
| | - Pierre Weinbreck
- Direction of Advanced Therapies, Human Products and Vaccines; French National Agency of Medicine and Health Products Safety-ANSM (ex Afssaps); Saint-Denis France
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82
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83
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Benjamin RJ. Pathogen inactivation - defining ‘adequate’ bacterial protection. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R. J. Benjamin
- American Red Cross Holland Laboratories; Rockville MD USA
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84
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Characterization of the growth dynamics and biofilm formation of Staphylococcus epidermidis strains isolated from contaminated platelet units. J Med Microbiol 2014; 63:884-891. [DOI: 10.1099/jmm.0.071449-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bacterial contamination of platelet concentrates (PCs) poses the highest transfusion-associated infectious risk, with Staphylococcus epidermidis being a predominant contaminant. Herein, the growth dynamics of 20 S. epidermidis strains in PCs and regular media were characterized. Strains were categorized as fast (short lag phase) or slow (long lag phase) growers in PCs. All strains were evaluated for the presence of the biofilm-associated icaAD genes by PCR, their capability to produce extracellular polysaccharide (slime) on Congo red agar plates and their ability to form surface-attached aggregates (biofilms) in glucose-supplemented trypticase soy broth (TSBg) using a crystal violet staining assay. A subset of four strains (two slow growers and two fast growers) was further examined for the ability for biofilm formation in PCs. Two of these strains carried the icAD genes, formed slime and produced biofilms in TSBg and PCs, while the other two strains, which did not carry icaAD, did not produce slime or form biofilms in TSBg. Although the two ica-negative slime-negative strains did not form biofilms in media, they displayed a biofilm-positive phenotype in PCs. Although all four strains formed biofilms in PCs, the two slow growers formed significantly more biofilms than the fast growers. Furthermore, growth experiments of the two ica-positive strains in plasma-conditioned platelet bags containing TSBg revealed that a slow grower isolate was more likely to escape culture-based screening than a fast grower strain. Therefore, this study provides novel evidence that links S. epidermidis biofilm formation with slow growth in PCs and suggests that slow-growing biofilm-positive S. epidermidis would be more likely to be missed with automate culture.
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85
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Taha M, Kalab M, Yi QL, Landry C, Greco-Stewart V, Brassinga AK, Sifri CD, Ramirez-Arcos S. Biofilm-forming skin microflora bacteria are resistant to the bactericidal action of disinfectants used during blood donation. Transfusion 2014; 54:2974-82. [DOI: 10.1111/trf.12728] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Mariam Taha
- Canadian Blood Services; Ottawa Ontario Canada
| | | | - Qi-Long Yi
- Canadian Blood Services; Ottawa Ontario Canada
| | | | | | | | - Costi D. Sifri
- University of Virginia Health System; Charlottesville Virginia
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86
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Heaton WA, Good CE, Galloway-Haskins R, Yomtovian RA, Jacobs MR. Evaluation of a rapid colorimetric assay for detection of bacterial contamination in apheresis and pooled random-donor platelet units. Transfusion 2014; 54:1634-41. [DOI: 10.1111/trf.12603] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 12/26/2022]
Affiliation(s)
- W. Andrew Heaton
- Blood Component Research Laboratory; Feinstein Institute for Medical Research; Manhasset New York
| | - Caryn E. Good
- Department of Pathology; Case Western Reserve University; Cleveland Ohio
- Department of Pathology; University Hospitals Case Medical Center; Cleveland Ohio
| | - Rakijah Galloway-Haskins
- Blood Component Research Laboratory; Feinstein Institute for Medical Research; Manhasset New York
| | - Roslyn A. Yomtovian
- Department of Pathology; Case Western Reserve University; Cleveland Ohio
- Department of Pathology and Laboratory Medicine; Louis Stokes VA Medical Center; Cleveland Ohio
| | - Michael R. Jacobs
- Department of Pathology; Case Western Reserve University; Cleveland Ohio
- Department of Pathology; University Hospitals Case Medical Center; Cleveland Ohio
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87
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Corash L. Bacterial contamination of platelet components: potential solutions to prevent transfusion-related sepsis. Expert Rev Hematol 2014; 4:509-25. [DOI: 10.1586/ehm.11.53] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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88
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Bacterial screening of platelet concentrates on day 2 and 3 with flow cytometry: the optimal sampling time point? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:388-95. [PMID: 24887230 DOI: 10.2450/2014.0175-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is growing concern on the residual risk of bacterial contamination of platelet concentrates in Germany, despite the reduction of the shelf-life of these concentrates and the introduction of bacterial screening. In this study, the applicability of the BactiFlow flow cytometric assay for bacterial screening of platelet concentrates on day 2 or 3 of their shelf-life was assessed in two German blood services. The results were used to evaluate currently implemented or newly discussed screening strategies. MATERIALS AND METHODS Two thousand and ten apheresis platelet concentrates were tested on day 2 or day 3 after donation using BactiFlow flow cytometry. Reactive samples were confirmed by the BacT/Alert culture system. RESULTS Twenty-four of the 2,100 platelet concentrates tested were reactive in the first test by BactiFlow. Of these 24 platelet concentrates, 12 were false-positive and the other 12 were initially reactive. None of the microbiological cultures of the initially reactive samples was positive. Parallel examination of 1,026 platelet concentrates by culture revealed three positive platelet concentrates with bacteria detected only in the anaerobic culture bottle and identified as Staphylococcus species. Two platelet concentrates were confirmed positive for Staphylcoccus epidermidis by culture. Retrospective analysis of the growth kinetics of the bacteria indicated that the bacterial titres were most likely below the diagnostic sensitivity of the BactiFlow assay (<300 CFU/mL) and probably had no transfusion relevance. CONCLUSIONS The BactiFlow assay is very convenient for bacterial screening of platelet concentrates independently of the testing day and the screening strategy. Although the optimal screening strategy could not be defined, this study provides further data to help achieve this goal.
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89
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Vollmer T, Knabbe C, Dreier J. Novel flow cytometric screening method for bacterial contamination of red blood cells: a proof-of-principle evaluation. Transfusion 2013; 54:900-9. [DOI: 10.1111/trf.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 10/19/2013] [Accepted: 10/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Tanja Vollmer
- Institut für Laboratoriums- und Transfusionsmedizin; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen Germany
| | - Cornelius Knabbe
- Institut für Laboratoriums- und Transfusionsmedizin; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen Germany
| | - Jens Dreier
- Institut für Laboratoriums- und Transfusionsmedizin; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen Germany
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90
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Zweitzig DR, Riccardello NM, Pester JM, Jeanmonod R, Kopnitsky MJ, O'Hara SM. A novel approach for rapid detection of bacterially contaminated platelet concentrates via sensitive measurement of microbial DNA polymerase activity. Transfusion 2013; 54:1642-51. [PMID: 24191780 DOI: 10.1111/trf.12487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/06/2013] [Accepted: 09/18/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transfusion of bacterially contaminated platelet concentrates (PCs) can result in serious health consequences for the affected patient. Before being released from blood banking facilities, PCs are routinely screened for bacterial contamination by culture-based tests. However, culture-based PC screening methods require extended holding and incubation periods and are prone to false-negative results due to sampling error. Screening PCs closer to the time of transfusion using rapid point-of-issue tests represents an alternative approach; however, FDA-approved assays generally suffer from a lack of sensitivity. STUDY DESIGN AND METHODS Presented herein is the feasibility of a novel approach toward rapid, sensitive, and universal detection of bacterially contaminated PCs via selective measurement of microbial DNA polymerase activity. This approach is achieved using a differential cell lysis procedure in combination with enzymatic template generation and amplification (termed ETGA-PC assay). RESULTS Serial dilution spiking experiments revealed an approximate sensitivity of 30 to 200 colony-forming units (CFUs)/mL (mean, 85 CFUs/mL) for Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. An additional 22 clinically relevant strains of bacteria were also detected below 200 CFUs/mL after spiking into PC aliquots. Furthermore, the ETGA-PC assay was able to accurately monitor the presence and growth of seven clinically relevant bacterial species that were spiked into PC units. CONCLUSION Together, the data presented here demonstrate that the ETGA-PC assay is a feasible approach for rapid and sensitive detection of bacterially contaminated PCs. Experiments, aimed at simplification and/or automation of the assay procedure, are under way.
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91
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Haesebaert J, Bénet T, Michallet M, Vanhems P. Septic shock during platelet transfusion in a patient with acute myeloid leukaemia. BMJ Case Rep 2013; 2013:bcr-2013-010412. [PMID: 24172770 DOI: 10.1136/bcr-2013-010412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although rare, transfusion-associated bacterial contamination (TABC) is nowadays the main risk associated with platelet concentrate (PC) transfusion. Consequences vary from spontaneously resolving symptoms to severe sepsis and death. In this report we have summarised a case of bacterial contamination and sepsis during PC transfusion in a patient with acute myeloid leukaemia. Fifteen minutes after the PC transfusion began, she developed chills and rapidly worsened to septic shock. The episode was managed appropriately. The patient's blood cultures and PC unit cultures grew Escherichia coli. The microbiological susceptibilities of isolates from the patient and platelet bag were identical. No other source of E coli was found. Donor and blood products issued from the same donation investigations were negative. The causality between sepsis and PC transfusion might be difficult to confirm. As no method is available in daily practice to eliminate TABC risk, physicians should always consider TABC by immediately stopping the transfusion and conducting appropriate investigations.
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Affiliation(s)
- Julie Haesebaert
- Department of Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Lyon, France
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92
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Hodgson SD, Greco-Stewart V, Jimenez CS, Sifri CD, Brassinga AKC, Ramirez-Arcos S. Enhanced pathogenicity of biofilm-negative Staphylococcus epidermidis isolated from platelet preparations. Transfusion 2013; 54:461-70. [PMID: 23795974 DOI: 10.1111/trf.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/22/2013] [Accepted: 04/29/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The platelet (PLT) storage environment triggers the formation of surface-attached aggregates known as biofilms by the common PLT contaminant Staphylococcus epidermidis. The biofilm matrix is largely composed of polysaccharide intercellular adhesin (PIA) mediated by the icaADBC operon. However, PIA-negative S. epidermidis has been reported to form biofilms in PLT concentrates (PCs). Since biofilm formation is associated with increased virulence, this study was aimed at determining if PIA-negative S. epidermidis grown in PCs presents enhanced virulence using the nematode Caenorhabditis elegans as a host model for bacterial pathogenesis. STUDY DESIGN AND METHODS Biofilm-positive S. epidermidis ATCC 35984 and 9142, which carry the icaADBC operon, and biofilm-negative S. epidermidis ATCC 12228 and 9142 ΔicaA were grown in regular media and in PCs and biofilm formation was quantified using a crystal violet assay. The virulence of these strains after passage through PCs was tested using nematode killing assays. Nematode survival was calculated using the Kaplan-Meier method and statistical differences were determined by log-rank analysis. RESULTS All S. epidermidis strains were able to form biofilms in PCs. Although persistence of a biofilm-positive phenotype in the biofilm-negative strains grown in PCs was not observed after passage in regular medium, the virulence of all strains was significantly increased as demonstrated by shortened life spans of the nematodes in C. elegans killing assays. CONCLUSION Our findings highlight the potential of an increased risk of nosocomial infections caused by S. epidermidis in transfusion recipients since PC storage conditions promote biofilm formation, and possibly pathogenicity, of strains traditionally known to be attenuated for virulence.
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Affiliation(s)
- Scott D Hodgson
- Department of Microbiology, Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Canadian Blood Services, Ottawa, Ontario, Canada
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93
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Affiliation(s)
- C. P. McDonald
- National Bacteriology Laboratory; National Health Service Blood and Transplant; London; UK
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94
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Girona-Llobera E, Jimenez-Marco T, Galmes-Trueba A, Muncunill J, Serret C, Serra N, Sedeño M. Reducing the financial impact of pathogen inactivation technology for platelet components: our experience. Transfusion 2013; 54:158-68. [DOI: 10.1111/trf.12232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Enrique Girona-Llobera
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Teresa Jimenez-Marco
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Ana Galmes-Trueba
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Josep Muncunill
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Carmen Serret
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Neus Serra
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Matilde Sedeño
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
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95
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Tomasulo PA, Wagner SJ. Predicting improvement in detection of bacteria in apheresis platelets by maintaining constant component sampling proportion. Transfusion 2013; 53:835-42. [PMID: 22845800 DOI: 10.1111/j.1537-2995.2012.03821.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In spite of interventions, approximately 1000 per 1,000,000 platelet (PLT) collections are contaminated with bacteria at collection. The current prestorage culture procedure at some blood centers is to inoculate a fixed volume from the collection bag (4-8 mL) regardless of collection volume. The sensitivity of early testing varies with the percent of collection volume sampled. We applied the Poisson model to determine whether sampling larger volumes might increase detection at pertinent contamination levels. STUDY DESIGN AND METHODS The intervention was testing a fixed proportion of the collection volume from single, double, and triple collections. The Poisson model was applied to blood center data to calculate weighted average detection. Model 1 consisted of inoculating 3.2% of the collection volume from single, 1.6% from double, and 1.2% from triple PLT procedures (8 mL in each case). Model 2 consisted of inoculating 3.8% of the collection volume from all PLT procedures. Volume-related and non-volume-related contamination mechanisms were evaluated. RESULTS Testing constant proportions of the collection volume (Model 2) increases percent detection over testing constant volumes (Model 1) (68% vs. 41% detection if contamination is 30 colony-forming units (CFUs)/collection bag and 17% vs. 9% detection if contamination is 5 CFUs/collection bag). At low levels of contamination (approx. 5 CFUs/bag), the intervention might double the number of contaminated units detected. CONCLUSION Based on the application of the Poisson model to detection of bacteria in PLT concentrates, inoculating cultures with slightly consistent proportions of the collection volume should lead to a reduction in false negative tests and in the number of contaminated units transfused.
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Affiliation(s)
- Peter A Tomasulo
- Medical and Scientific Affairs, Blood Services, Inc., Scottsdale, AZ 85257, USA.
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96
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Jacobs MR, Good CE, Fox RM, Roman KP, Lazarus HM. Microbial contamination of hematopoietic progenitor and other regenerative cells used in transplantation and regenerative medicine. Transfusion 2013; 53:2690-6. [PMID: 23461309 DOI: 10.1111/trf.12150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 12/27/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Microbial contamination of hematopoietic progenitor cells (HPCs) and other regenerative cells used in transplantation and regenerative medicine can occur during collection and after in vitro manipulation, including purging, cryopreservation, thawing, and infusion. STUDY DESIGN AND METHODS Microbiologic culture findings on consecutive HPCs and other cell preparations at a single institution derived from peripheral blood, marrow, cord blood, and mesenchymal stromal cells during all phases of manipulation were retrospectively examined from 2005 through 2011. Results were classified as confirmed positive, false positive, and indeterminate. RESULTS During the 6-year surveillance period, 365 patients underwent 912 procedures involving HPC or other cell-based transfusion. True positive microbial contamination was found in five of 663 (0.8%) peripheral blood and two of 34 (5.9%) marrow preparations (p = 0.04), while no contamination was found in 118 preparations from other sources. True-positive microbial contaminants included coagulase-negative staphylococci in autologous HPC products derived from peripheral blood from two patients with asymptomatic central venous catheter infections at time of apheresis and Propionibacterium acnes in one apheresis and two marrow products. Organism loads were low in all cases (≤500 colony-forming units/mL), and no adverse sequelae occurred in four patients that received contaminated products. CONCLUSION The incidence of microbial contamination of progenitor cell products in our institution over a 6-year period was low (0.8% overall), with contaminants originating from infected central venous catheters or from skin flora. All contaminants were bacterial species of low virulence, present in low titers and, if transfused, did not result in adverse reactions.
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Affiliation(s)
- Michael R Jacobs
- Departments of Pathology and Medicine and Case Comprehensive Cancer Center, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio
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97
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Ramirez-Arcos S, Perkins H, Kou Y, Mastronardi C, Kumaran D, Taha M, Yi QL, McLaughlin N, Kahwash E, Lin Y, Acker J. Bacterial growth in red blood cell units exposed to uncontrolled temperatures: challenging the 30-minute rule. Vox Sang 2013; 105:100-7. [DOI: 10.1111/vox.12027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 12/28/2012] [Accepted: 12/31/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - H. Perkins
- Canadian Blood Services; Ottawa; ON; Canada
| | - Y. Kou
- Canadian Blood Services; Ottawa; ON; Canada
| | | | - D. Kumaran
- Canadian Blood Services; Ottawa; ON; Canada
| | - M. Taha
- Canadian Blood Services; Ottawa; ON; Canada
| | - Q.-L. Yi
- Canadian Blood Services; Ottawa; ON; Canada
| | | | - E. Kahwash
- Canadian Blood Services; Halifax; NS; Canada
| | - Y. Lin
- Sunnybrook Health Sciences Centre; Toronto; ON; Canada
| | - J. Acker
- Canadian Blood Services; Edmonton; AB; Canada
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98
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Bacteriological analysis of platelets and cases of septic reactions associated with transfusion of contaminated samples. Transfus Apher Sci 2012; 47:313-8. [DOI: 10.1016/j.transci.2012.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 06/29/2012] [Indexed: 11/17/2022]
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99
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Kleinman S, Reed W, Stassinopoulos A. A patient-oriented risk-benefit analysis of pathogen-inactivated blood components: application to apheresis platelets in the United States. Transfusion 2012; 53:1603-18. [DOI: 10.1111/j.1537-2995.2012.03928.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 12/21/2022]
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100
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Torres R, Kenney B, Tormey CA. Diagnosis, Treatment, and Reporting of Adverse Effects of Transfusion. Lab Med 2012. [DOI: 10.1309/lm3naabjjk1hnyfu] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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