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O’Flaherty N, Bryce L, Nolan J, Lambert M. Changing Strategies for the Detection of Bacteria in Platelet Components in Ireland: From Primary and Secondary Culture (2010-2020) to Large Volume Delayed Sampling (2020-2023). Microorganisms 2023; 11:2765. [PMID: 38004776 PMCID: PMC10673373 DOI: 10.3390/microorganisms11112765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Bacterial contamination of platelet components (PC) poses the greatest microbial risk to recipients, as bacteria can multiply over the course of PC storage at room temperature. Between 2010 and 2020, the Irish Blood Transfusion Service (IBTS) screened over 170,000 buffy coat-derived pooled (BCDP) and single-donor apheresis platelets (SDAPs) with the BACT/ALERT 3D microbial detection system (Biomerieux, L'Etoile, France), using a two-step screening protocol which incorporated primary and secondary cultures. Although the protocol was successful in averting septic transfusion reactions (STRs), testing large sample volumes at later time points was reported to improve detection of bacterial contamination. A modified large-volume delayed sampling (LVDS)-type protocol was adopted in 2020, which in the case of SDAP was applied to collections rather than individual splits (2020-2023, 44,642 PC screened). Rates of bacterial contamination for BCDP were 0.125% on Day-2, 0.043% on Day-4 vs. 0.191% in the post-LVDS period. SDAP contamination rates in the pre-LVDS period were 0.065% on Day-1, 0.017% on Day-4 vs. 0.072% in the post-LVDS period. Confirmed STRs were absent, and the interdiction rate for possibly contaminated SDAP was over 70%. In the post-LVDS period, BCDPs had a higher total positivity rate than SDAPs, 0.191% (1:525) versus 0.072% (1:1385), respectively, (chi-squared 12.124, 1 df, p = 0.0005). The majority of organisms detected were skin-flora-type, low pathogenicity organisms, including coagulase-negative staphylococci and Cutibacterium acnes, with little change in the frequency of clinically significant organisms identified over time. Both protocols prevented the issue of potentially harmful components contaminated (rarely) with a range of pathogenic bacteria, including Escherichia coli, Serratia marcesens, Staphylococcus aureus, and streptococci. Culture positivity of outdates post-LVDS whereby 100% of expired platelets are retested provides a residual risk estimate of 0.06% (95% CI 0.016-0.150). However, bacterial contamination rates in expired platelets did not demonstrate a statistically significant difference between the pre-LVDS 0.100% (CI 0.033-0.234) and post-LVDS 0.059% (0.016-0.150) periods (chi-squared = 0.651, 1 df, p = 0.42).
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Affiliation(s)
- Niamh O’Flaherty
- Irish Blood Transfusion Service, National Blood Centre, D08 NH5R Dublin, Ireland; (L.B.); (M.L.)
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2
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Odunayo A, Nash KJ, Davidow EB, Blois SL, Goy-Thollot I, Harris L, Humm K, Musulin S, Sharp CR, Spada E, Thomason J, Walton J, Jane Wardrop K. Association of Veterinary Hematology and Transfusion Medicine (AVHTM) transfusion reaction small animal consensus statement (TRACS). Part 3: Diagnosis and treatment. J Vet Emerg Crit Care (San Antonio) 2021; 31:189-203. [PMID: 33751797 DOI: 10.1111/vec.13043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To systematically review available evidence to develop guidelines for diagnosis and treatment of transfusion-associated reactions in dogs and cats. DESIGN Standardized and systemic evaluation of the literature (identified through Medline via PubMed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. The available evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. The evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines, diagnostic, and treatment algorithms were generated based on the evaluation of the evidence. Consensus on the final guidelines was achieved through Delphi-style surveys. Draft recommendations were disseminated through veterinary specialty listservs for review and comments, which were evaluated and integrated prior to final publication. RESULTS Medline via PubMed and Google Scholar databases were searched. There were 14 Population Intervention Comparison Outcome questions identified and corresponding worksheets were developed focusing on the diagnosis and treatment of transfusion-associated reactions in dogs and cats. Fourteen guidelines and four algorithms were developed with a high degree of consensus. CONCLUSIONS This systematic evidence evaluation process yielded recommended diagnostic and treatment algorithms for use in practice. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.
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Affiliation(s)
- Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, Tennessee, USA
| | - Katherine J Nash
- VetMED Emergency and Specialty Veterinary Hospital, Phoenix, Arizona, USA
| | - Elizabeth B Davidow
- Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | | | | | - Karen Humm
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Sarah Musulin
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Eva Spada
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - John Thomason
- Department of Clinical Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | | | - K Jane Wardrop
- Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
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3
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Allen ES, Vincent C, Reeve DA, Kopko PM. Phased implementation of pathogen-reduced platelets in a health system facilitates increased manufacturing at the blood center. Transfusion 2019; 59:3120-3127. [PMID: 31408203 PMCID: PMC6852374 DOI: 10.1111/trf.15480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pathogen reduction treatment (PRT) reduces the risk of transfusion‐transmitted infections from established and emerging organisms. Manufacturing, however, is complex. In our university health system, we phased in pathogen‐reduced platelets (PR PLTs) by patient population. We then assessed the implementation strategy and investigated factors in the supply chain that prevented us from meeting the goal of providing greater than 90% PR PLTs within 6 months. STUDY DESIGN AND METHODS In Phase 1, PR PLTs were provided in the outpatient cancer center. Phase 2 added inpatients undergoing bone marrow transplantation, and Phase 3 included all patients. In Phase 4, the blood center implemented manufacturing optimization strategies. Product supply and usage during the first 23 months after implementation were evaluated. Investigation of the supply chain included analysis of (1) the number of in‐state hospitals receiving PR PLTs; (2) the fraction of products eligible for PRT before and after manufacturing improvements. RESULTS During Phases 1 and 2, PR products comprised 44% and 53% of PLTs transfused in the phased‐in areas. At 6 months, 41% of PLTs were PR, and at 23 months, 92%. The fraction of PR PLTs transfused in our system correlated logarithmically with the number of in‐state hospitals receiving them (R2 = 0.71) and the number of PR PLTs sold to those hospitals (R2 = 0.80). CONCLUSION Phased implementation is a practical and ethical way to introduce PR PLTs in a health system and facilitates scalability at the blood center. Widespread availability of PR products may require collective action and can be increased by optimization strategies during manufacturing. http://onlinelibrary.wiley.com/doi/10.1111/trf.15500/full
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Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California
| | | | | | - Patricia M Kopko
- Department of Pathology, University of California San Diego, La Jolla, California
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4
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Existing and Emerging Blood-Borne Pathogens: Impact on the Safety of Blood Transfusion for the Hematology/Oncology Patient. Hematol Oncol Clin North Am 2019; 33:739-748. [PMID: 31466601 DOI: 10.1016/j.hoc.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite measures to mitigate risk of transfusion-transmitted infections, emerging agents contribute to morbidity and mortality. We outline the epidemiology, risk mitigation strategies, and impact on patients for Zika virus, bacteria, Babesia, and cytomegalovirus. Nucleic acid testing of blood has reduced risk of Zika infection and reduced transfusion-transmitted risk of Babesia. Other collection and testing measures have reduced but not eliminated the risk of sepsis from bacterially contaminated blood components. Cytomegalovirus has almost been eliminated by high-efficiency leukoreduction, but residual transmissions are difficult to distinguish from community-acquired infections and additional antibody testing of blood may confer further safety of susceptible recipients.
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5
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Wood EM, Ang AL, Bisht A, Bolton-Maggs PH, Bokhorst AG, Flesland O, Land K, Wiersum-Osselton JC, Schipperus MR, Tiberghien P, Whitaker BI. International haemovigilance: what have we learned and what do we need to do next? Transfus Med 2019; 29:221-230. [PMID: 30729612 DOI: 10.1111/tme.12582] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/05/2018] [Accepted: 01/12/2019] [Indexed: 02/06/2023]
Abstract
The International Haemovigilance Network (IHN) defines haemovigilance as 'a set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients), intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence'. IHN, the International Society of Blood Transfusion and World Health Organization work together to support both developing and established haemovigilance systems. Haemovigilance systems provide valuable data on a range of adverse events related to blood donation and clinical transfusion, from donor syncopal events to transfusion-transmitted infections, immunological complications and the impact of human errors. Harmonised definitions for most adverse reactions have been developed and validated internationally. Definitions of pulmonary complications are again under review. Haemovigilance data have resulted in changes in policy, products and practice, and can complement and inform clinical audit and research, leading to improved blood donor safety, optimised product use and better clinical outcomes after transfusion. However, more work is needed. Not all countries have haemovigilance systems in place. More robust data and careful analysis are required to improve the understanding of the causes, occurrence and clinical outcomes of these events. Wider dissemination of results will facilitate health policy development internationally, and implementation of haemovigilance recommendations will support further important progress in blood safety.
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Affiliation(s)
- E M Wood
- Transfusion Research Unit, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - A L Ang
- Blood Services Group, Health Sciences Authority, Singapore.,Department of Haematology, Singapore General Hospital, Singapore
| | - A Bisht
- Haemovigilance Programme of India, National Institute of Biologicals, Ministry of Health & Family Welfare, Noida, India
| | - P H Bolton-Maggs
- Serious Hazards of Transfusion, Manchester, UK.,University of Manchester, Manchester, UK
| | - A G Bokhorst
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - O Flesland
- Norwegian Directorate of Health, Oslo, Norway
| | - K Land
- Blood Systems Inc., Tempe, Arizona, USA.,Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - J C Wiersum-Osselton
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - M R Schipperus
- Transfusion and Transplantation Reactions in Patients (TRIP), National Haemovigilance and Biovigilance Office, Leiden, The Netherlands.,Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - P Tiberghien
- Etablissement Français du Sang, La Plaine St Denis, France.,Université de Franche-Comté, Inserm, EFS, UMR 1098, Besançon, France
| | - B I Whitaker
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Review US Food & Drug Administration, Silver Spring, Maryland, USA
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Boudreau G, Carli C, Lamarche C, Rulleau C, Bonnaure G, Néron S, Delisle JS. Leukoreduction system chambers are a reliable cellular source for the manufacturing of T-cell therapeutics. Transfusion 2018; 59:1300-1311. [DOI: 10.1111/trf.15121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Gabrielle Boudreau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Cédric Carli
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Caroline Lamarche
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Caroline Rulleau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Guillaume Bonnaure
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Medical Affairs and Innovation; Héma-Québec; Québec Québec Canada
| | - Sonia Néron
- Medical Affairs and Innovation; Héma-Québec; Québec Québec Canada
- Department of Biochemistry, Microbiology and Bio-informatics; Université Laval; Québec Québec Canada
| | - Jean-Sébastien Delisle
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Hematology-Oncology Division; Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Department of Medicine; Université de Montréal; Montreal Québec Canada
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7
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Bordetella holmesii Contamination of Platelet Concentrates: Revisiting the Definition of a Positive Culture. J Clin Microbiol 2018; 56:JCM.01105-18. [PMID: 30158191 DOI: 10.1128/jcm.01105-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/16/2018] [Indexed: 11/20/2022] Open
Abstract
Bacterial contamination remains the most important infectious risk of platelet transfusion. After an initially positive result, a second test is performed on the blood products and the initial culture bottle to confirm the contamination. Based on the blood center's decision algorithm used, results can be either confirmed negative, positive, or indeterminate, or be unconfirmed or discordant. Here, we report the first cases of platelet concentrates contaminated with Bordetella holmesii The in vitro growth characteristics of this unusual contaminant in platelet concentrate were investigated. Two B. holmesii strains isolated from platelet concentrates, as well as a control strain (Serratia marcescens), were spiked into platelet concentrates (PCs) at 1 and 10 CFU/ml. PCs were stored at 20 to 24°C under agitation. Samples were collected on days 2, 3, 4, and 7 for colony count and for bacterial screening using the BacT/Alert 3D system. Two PCs were detected as being positive for B. holmesii However, recultures were negative. In vitro, B. holmesii did not grow but remained detectable in PCs. Its viability diminished rapidly in contact with human plasma. Upon screening using the BacT/Alert 3D system, the majority of products spiked with B. holmesii were negative. This is the first description of PCs contaminated with B. holmesii This bacterium survives in blood products and remains dormant at low concentrations in blood products stored at room temperature, thus making difficult its detection with the BacT/Alert 3D system. The present definition of a true-positive culture of PCs may be overly restrictive for certain bacterial strains.
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8
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Störmer M, Wood EM, Gathof B. Microbial safety of cellular therapeutics-lessons from over ten years’ experience in microbial safety of platelet concentrates. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Störmer
- Transfusion Medicine; University Hospital Cologne; Cologne Germany
| | - Erica M. Wood
- Transfusion Research Unit; Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - Birgit Gathof
- Transfusion Medicine; University Hospital Cologne; Cologne Germany
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9
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Brailsford SR, Tossell J, Morrison R, McDonald CP, Pitt TL. Failure of bacterial screening to detect Staphylococcus aureus: the English experience of donor follow-up. Vox Sang 2018; 113:540-546. [PMID: 29799121 DOI: 10.1111/vox.12670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Between February 2011 and December 2016, over 1·6 million platelet units, 36% pooled platelets, underwent bacterial screening prior to issue. Contamination rates for apheresis and pooled platelets were 0·02% and 0·07%, respectively. Staphylococcus aureus accounted for 21 contaminations, including four pooled platelets, one confirmed transfusion-transmitted infection (TTI) and three 'near-miss' incidents detected on visual inspection which were negative on screening. We describe follow-up investigations of 16 donors for skin carriage of S. aureus and molecular characterisation of donor and pack isolates. MATERIALS AND METHODS Units were screened by the BacT/ALERT 3D detection system. Contributing donors were interviewed and consent requested for skin and nasal swabbing. S. aureus isolates were referred for spa gene type and DNA macrorestriction profile to determine identity between carriage strains and packs. RESULTS Donors of 10 apheresis and two pooled packs screen positive for S. aureus were confirmed as the source of contamination; seven had a history of skin conditions, predominantly eczema; 11 were nasal carriers. The 'near-miss' incidents were associated with apheresis donors, two donors harboured strains indistinguishable from the pack strain. The TTI was due to a screen-negative pooled unit, and a nasal isolate of one donor was indistinguishable from that in the unit. CONCLUSION Staphylococcus aureus contamination is rare but potentially harmful in platelet units. Donor isolates showed almost universal correspondence in molecular type with pack isolates, thus confirming the source of contamination. The importance of visual inspection of packs prior to transfusion is underlined by the 'near-miss' incidents.
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Affiliation(s)
- S R Brailsford
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - J Tossell
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - R Morrison
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - C P McDonald
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - T L Pitt
- Microbiology Services, NHS Blood and Transplant, London, UK
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10
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Chetouane Y, Dubourg G, Gallian P, Delerce J, Levasseur A, Flaudrops C, Chabrière E, Chiaroni J, Raoult D, Camoin-Jau L. In vitro detection of bacterial contamination in platelet concentrates by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry: a preliminary study. J Med Microbiol 2017; 66:1523-1530. [PMID: 28984240 DOI: 10.1099/jmm.0.000533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Platelet concentrates are at risk of transfusion-related sepsis. The microbial detection methods currently available have reached their limits, as they do not completely prevent transfusion-related bacterial contamination.The aim of this study was to develop a new strategy to detect the risk of platelet transfusion-related bacterial contamination using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). METHODOLOGY In vitro, platelet concentrates were seeded with known concentrations of bacterial strains. Protein mass profiles were acquired by using a Microflex MALDI-TOF instrument. Dedicated 'Platelet' software was used as a spectrum subtraction tool to reveal specific peaks caused by the presence of pathogens in samples. RESULTS The MALDI-TOF spectra of platelets were characterized and the reproducibility over time, regardless of the blood donor, was demonstrated with a positive predictive value of 100 %. In addition, the negative predictive value of the total number of specific peaks to predict contamination was 100 %. CONCLUSION Detecting bacteria in platelet concentrates using the MALDI-TOF approach and analysing spectra with the Platelet software present the advantage of combining the precocity of results and sufficient sensitivity (10 c.f.u. ml-1). Further research will be conducted to compare this novel method with the current conventional method in order to validate our results, the objective being to reduce the risk of platelet transfusion-related bacterial contamination.
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Affiliation(s)
- Yasmine Chetouane
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Gregory Dubourg
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Pierre Gallian
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France.,Etablissement Français du Sang (EFS), La Plaine Saint-Denis, France
| | - Jeremy Delerce
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Anthony Levasseur
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Christophe Flaudrops
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Eric Chabrière
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Jacques Chiaroni
- Etablissement Français du Sang (EFS), La Plaine Saint-Denis, France.,Aix-Marseille Université, CNRS, EFS, ADES UMR 7268, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
| | - Laurence Camoin-Jau
- AP-HM, Laboratoire d'Hématologie, CHU Timone, Marseille, France.,Aix-Marseille Université, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, CNRS UMR 7278, IRD 198, Marseille, France
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11
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Abela MA, Fenning S, Maguire KA, Morris KG. Bacterial contamination of platelet components not detected by BacT/ALERT ®. Transfus Med 2017; 28:65-70. [PMID: 28875548 DOI: 10.1111/tme.12458] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/31/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the possible causes for false negative results in BacT/ALERT® 3D Signature System despite bacterial contamination of platelet units. BACKGROUND The Northern Ireland Blood Transfusion Service (NIBTS) routinely extends platelet component shelf life to 7 days. Components are sampled and screened for bacterial contamination using an automated microbial detection system, the BacT/ALERT® 3D Signature System. We report on three platelet components with confirmed bacterial contamination, which represent false negative BacT/ALERT® results and near-miss serious adverse events. METHODS NIBTS protocols for risk reduction of bacterial contamination of platelet components are described. The methodology for bacterial detection using BacT/ALERT® is outlined. Laboratory tests, relevant patient details and relevant follow-up information are analysed. RESULTS In all three cases, Staphylococcus aureus was isolated from the platelet residue and confirmed on terminal sub-culture using BacT/ALERT® . In two cases, S. aureus with similar genetic makeup was isolated from the donors. CONCLUSION Risk reduction measures for bacterial contamination of platelet components are not always effective. Automated bacterial culture detection does not eliminate the risk of bacterial contamination. Visual inspection of platelet components prior to release, issue and administration remains an important last line of defence.
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Affiliation(s)
- M A Abela
- Medical Department, Northern Ireland Blood Transfusion Service, Belfast, UK
| | - S Fenning
- Bacteriology Laboratory, Quality Department, Northern Ireland Blood Transfusion Service, Belfast, UK
| | - K A Maguire
- Medical Department, Northern Ireland Blood Transfusion Service, Belfast, UK
| | - K G Morris
- Medical Department, Northern Ireland Blood Transfusion Service, Belfast, UK
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12
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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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13
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Delaney M, Wendel S, Bercovitz RS, Cid J, Cohn C, Dunbar NM, Apelseth TO, Popovsky M, Stanworth SJ, Tinmouth A, Van De Watering L, Waters JH, Yazer M, Ziman A. Transfusion reactions: prevention, diagnosis, and treatment. Lancet 2016; 388:2825-2836. [PMID: 27083327 DOI: 10.1016/s0140-6736(15)01313-6] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.
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Affiliation(s)
- Meghan Delaney
- Bloodworks NW, Seattle, WA, USA; University of Washington, Department of Laboratory Medicine, Seattle, WA, USA.
| | | | | | - Joan Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clínic, UB, Barcelona, Spain
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Nancy M Dunbar
- Department of Pathology and Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Torunn O Apelseth
- Laboratory of Clinical Biochemistry and Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Simon J Stanworth
- NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK; Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alan Tinmouth
- Department of Medicine and Department of Laboratory Medicine & Pathology, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jonathan H Waters
- Department of Anesthesiology & Bioengineering, University of Pittsburgh & McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
| | - Mark Yazer
- Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Institute for Transfusion Medicine, Pittsburgh, PA, USA
| | - Alyssa Ziman
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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14
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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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15
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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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16
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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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17
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Chung KW, Harvey A, Basavaraju SV, Kuehnert MJ. How is national recipient hemovigilance conducted in the United States? Transfusion 2015; 55:703-7. [PMID: 25565577 DOI: 10.1111/trf.12980] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022]
Abstract
A national recipient hemovigilance system was introduced in the United States in 2010, when voluntary enrollment began as part of the National Healthcare Safety Network (NHSN) Hemovigilance Module. NHSN is a secure, Web-based surveillance system operated by the Centers for Disease Control and Prevention and used by US health care facilities to report a variety of patient safety information. The Hemovigilance Module is used for comprehensive monitoring of transfusion-related adverse events. Participating facilities can utilize analytic tools available within the module to identify opportunities for enhancing transfusion safety, evaluate the effectiveness of interventions, and compare facility specific transfusion-related data to aggregate national estimates. Data may be voluntarily shared by facilities with external partners for patient safety improvement initiatives and to fulfill reporting mandates. We describe the key characteristics of the Hemovigilance Module, highlight the benefits for participating facilities, and discuss the use of reported data for establishing national estimates of transfusion-associated adverse events to identify gaps in transfusion safety and opportunities for interventions. National hemovigilance systems are essential to recognize gaps in transfusion safety and identify opportunities for interventions to improve patient safety and outcomes.
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Affiliation(s)
- Koo-Whang Chung
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexis Harvey
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V Basavaraju
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Kuehnert
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Wood EM, Stevenson L, Bielby L, Wiersum-Osselton JC. Haemovigilance: concepts and frameworks. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. M. Wood
- Transfusion Research Unit; Monash University; Melbourne Vic. Australia
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
| | - L. Stevenson
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
| | - L. Bielby
- Department of Health Victoria; Serious Transfusion Incident Reporting (STIR) system; Blood Matters Programme; Melbourne Vic. Australia
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19
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20
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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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21
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The International Experience of Bacterial Screen Testing of Platelet Components With an Automated Microbial Detection System: A Need for Consensus Testing and Reporting Guidelines. Transfus Med Rev 2014; 28:61-71. [DOI: 10.1016/j.tmrv.2014.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
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22
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Macdonald NE, O'Brien SF, Delage G. Transfusion and risk of infection in Canada: Update 2012. Paediatr Child Health 2013; 17:e102-6. [PMID: 24294070 DOI: 10.1093/pch/17.10.e102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although multiple critical steps are taken to minimize the risk of infection from transfusion of blood or blood products in developed countries, this risk can never be entirely eliminated. In Canada, the risks of noninfectious transfusion reactions, such as transfusion-related acute lung injury and major allergic or anaphylactic reactions, are greater than that of infection. This updated practice point provides an overview of transfusion infection risks in Canada. Infectious agents, systemic conditions, donor and recipient factors, and collection and infusion techniques are considered. Suggestions are offered to improve both system and process, and to help practitioners who are discussing informed consent with patients and parents before administering blood or a blood product.
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23
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Bolton-Maggs PHB, Cohen H. Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety. Br J Haematol 2013; 163:303-14. [PMID: 24032719 PMCID: PMC3935404 DOI: 10.1111/bjh.12547] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Serious Hazards of Transfusion (SHOT) UK confidential haemovigilance reporting scheme began in 1996. Over the 16 years of reporting, the evidence gathered has prompted changes in transfusion practice from the selection and management of donors to changes in hospital practice, particularly better education and training. However, half or more reports relate to errors in the transfusion process despite the introduction of several measures to improve practice. Transfusion in the UK is very safe: 2·9 million components were issued in 2012, and very few deaths are related to transfusion. The risk of death from transfusion as estimated from SHOT data in 2012 is 1 in 322 580 components issued and for major morbidity, 1 in 21 413 components issued; the risk of transfusion-transmitted infection is much lower. Acute transfusion reactions and transfusion-associated circulatory overload carry the highest risk for morbidity and death. The high rate of participation in SHOT by National Health Service organizations, 99·5%, is encouraging. Despite the very useful information gained about transfusion reactions, the main risks remain human factors. The recommendations on reduction of errors through a ‘back to basics’ approach from the first annual SHOT report remain absolutely relevant today.
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24
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MacDonald NE, O’Brien SF, Delage G. Les transfusions et le risque d’infection au Canada : mise à jour pour 2012. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.10.e107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Lee CK, Wong HK, Ho PL, Tsoi WC, Lee KY, Tsui GTF, Chua E, Leung JNS, Lin CK. Significant bacterial contamination risk reduction with the use of diversion pouch. Transfus Med 2012; 22:404-8. [DOI: 10.1111/j.1365-3148.2012.01194.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/05/2012] [Accepted: 09/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
- C. K. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - H. K. Wong
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - P. L. Ho
- Department of Microbiology; The University of Hong Kong; Hong Kong; SAR; China
| | - W. C. Tsoi
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - K. Y. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - G. T. F. Tsui
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - E. Chua
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - J. N. S. Leung
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - C. K. Lin
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
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26
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Wiersum-Osselton JC, van Tilborgh-de Jong AJW, Zijlker-Jansen PY, van de Watering LMG, Brand A, van der Bom JG, Schipperus MR. Variation between hospitals in rates of reported transfusion reactions: is a high reporting rate an indicator of safer transfusion? Vox Sang 2012; 104:127-34. [PMID: 22892067 DOI: 10.1111/j.1423-0410.2012.01642.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES It has been suggested that the rate of reported transfusion reactions is positively correlated with safety of the transfusion chain in a hospital. We evaluated this assumption in the Transfusion Reactions in Patients Dutch National Hemovigilance Office database taking reported incorrect blood component transfused as a proxy for unsafe transfusion. METHODS Reports from 2006 to 2010 and annual numbers of transfused blood components from the 103 hospitals were analysed. The rate of transfusion reactions per 1000 blood components was calculated per hospital. Logistic regression analysis was performed between reporting of at least one incorrect blood component and tertile of transfusion reaction rate. RESULTS Out of the 103 hospitals, 101 had complete data in some and 93 in all 5years. In all, 72 had reported at least one incorrect blood component transfused; this was associated with blood use level and also with rate of reported transfusion reactions: odds ratio 4·2 (95% confidence interval, 1·3-13·7) in the highest vs. the lowest tertile after adjustment for blood use level. CONCLUSION Hospitals in the Netherlands which report more transfusion reactions per 1000 units are also more likely to have reported incorrect blood component transfused. The data do not support that hospitals with a higher rate of transfusion reaction reports are safer.
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Affiliation(s)
- J C Wiersum-Osselton
- Transfusion Reactions in Patients (TRIP) Dutch National Hemovigilance Office, The Hague, The Netherlands.
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Leach Bennett J, Blajchman MA, Delage G, Fearon M, Devine D. Proceedings of a Consensus Conference: Risk-Based Decision Making for Blood Safety. Transfus Med Rev 2011; 25:267-92. [PMID: 21763103 DOI: 10.1016/j.tmrv.2011.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Funk MB, Lohmann A, Guenay S, Henseler O, Heiden M, Hanschmann KMO, Keller-Stanislawski B. Transfusion-Transmitted Bacterial Infections - Haemovigilance Data of German Blood Establishments (1997-2010). ACTA ACUST UNITED AC 2011; 38:266-271. [PMID: 22016698 DOI: 10.1159/000330372] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/31/2011] [Indexed: 11/19/2022]
Abstract
SUMMARY: METHODS: In order to evaluate the benefit of risk minimisation measures, reporting rates of transfusion-transmitted bacterial infections (TTBI) were calculated on the basis of annual reports and distributed blood components. Following the implementation of risk minimisation measures in 2003 and 2008, a comparison of pre- and post-implementation periods was performed. RESULTS: During a period of 14 years, 90 cases of TTBI were confirmed, 34 were caused by red blood cell (RBC) concentrates, 5 by fresh frozen plasma, and 51 by platelet concentrates (PCs). The overall reporting frequency was 1 TTBI in 1.91 million RBC units; 1 TTBI in 0.094 million PC units, and 1 TTBI-associated fatality in 0.57 million PC units. From 2001-2004 the reporting rate was 13.7 per million PC units; 2005-2008, after the implementation of pre-donation sampling; it was 10.8 per million PC units (p > 0.5). After limitation of the shelf life (2008), the reporting rate decreased to 4.49 per million PC units (p = 0.12), and one case of related fatality was reported. Agents with low pathogenicity were reported in 14 of 41 immunosuppressed patients (34%) but only in 1 of 13 patients with non-haematological/oncological diseases. CONCLUSION: TTBI and associated fatalities could be gradually reduced by the risk minimisation measures, but further strategies such as implementation of sensitive screening tests or pathogen-reducing approaches should be discussed.
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Affiliation(s)
- Markus B Funk
- Department of Safety of Medicinal Products and Medical Devices, Paul-Ehrlich-Institute Langen, Germany
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29
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Jenkins C, Ramírez-Arcos S, Goldman M, Devine DV. Bacterial contamination in platelets: incremental improvements drive down but do not eliminate risk. Transfusion 2011; 51:2555-65. [PMID: 21615745 DOI: 10.1111/j.1537-2995.2011.03187.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bacterial contamination of platelet components (PCs) remains an important cause of transfusion-associated infectious risk. In 2004, Canadian Blood Services (CBS) implemented bacterial testing of PCs using the BacT/ALERT 3D system (bioMérieux). This system has been validated and implemented and continuous monitoring of culture rates allows gathering of data regarding true and false positives as well as false negatives. STUDY DESIGN AND METHODS National data gathered between March 2004 and October 2010 from 12 CBS sites were analyzed to compare bacterial contamination rates across three platelet (PLT) preparation methods: apheresis, buffy coat, and PLT-rich plasma. Data were compared before and after implementation of protocol changes that may affect bacterial detection or contamination rates. RESULTS Initial positive rates among the three production methods were significantly different, with apheresis PCs being the highest. The rates of confirmed positives among production methods did not differ significantly (p = 0.668). Increasing sample testing volumes from 4 to 6 mL to 8 to 10 mL significantly increased the rate of initial positives, while confirmed positives increased from 0.64 to 1.63 per 10,000, approaching significance (p = 0.055). Changing the skin disinfection method from a two-step to a one-step protocol did not significantly alter the rate of confirmed positives. During the period of data analysis, eight false-negative cases were reported, with five implicated in adverse transfusion reactions. CONCLUSION Bacterial testing of PCs and implementation of improved protocols are incrementally effective in reducing the risk of transfusion of bacterially contaminated PLT concentrates; however, the continued occurrence of false-negative results means the risk has not been eliminated.
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