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Tadasa E, Adissu W, Bekele M, Arega G, Gedefaw L. Incidence of acute transfusion reactions and associated factors among adult blood-transfused patients at Jimma University Medical Center, southwest Ethiopia: A cross-sectional study. Medicine (Baltimore) 2024; 103:e39137. [PMID: 39121245 PMCID: PMC11315494 DOI: 10.1097/md.0000000000039137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 07/09/2024] [Indexed: 08/11/2024] Open
Abstract
Acute transfusion reaction is mainly related to the infusion of blood or blood products resulting at any time within a day of the intervention. It ranges from a non-specific febrile episode to a life-threatening intravascular hemolysis. The severity of the reaction and the degree of morbidity are usually related to the degree of ABO incompatibility and the volume of blood transfused. Therefore, this study aimed to determine the incidence of acute transfusion reactions and its associated factors in Jimma University Medical Center, southwest Ethiopia. Institution-based cross-sectional study was conducted from 1 October to December 30, 2020. A total of 384 transfused patients were followed in this study. Socio-demographic and clinical data were collected through a structured questionnaire. Baseline measurement and 24-hour periodic vital signs monitoring were conducted after each transfusion. Four milliliters of venous blood were drawn after transfusion intervention from each distrusted patient for complete blood count, blood group phenotype, direct antihuman globulin test (DAT), and crossmatching. Data were entered into Epi data version 3.1 and analyzed using Statistical Package for Social Science software (SPSS) version 20. Descriptive statistics, and bivariable and multivariable logistic regression were employed to test the association between independent and dependent variables. A P value ≤ .05 was considered to indicate statistical significance. Acute transfusion reactions were diagnosed in 5.7% of patients, with most of these reactions were febrile nonhemolytic reactions (63.6%) followed by allergic (36.4%) reactions with mild clinical manifestations (27.3%). Transfusion history, transfused blood that was kept for more than 13 days, abortion history, and number of transfused units (≥3 units of blood/blood component) have 3.3, 3.85, 4.2, and 3.9 times greater odds, respectively, besides their significant association with the incidence of acute transfusion reactions. Patients with a history of previous transfusion, abortion, multi-unit transfusion, and patients transfused with blood stored for ≥14 days should be closely monitored. Starting a hemovigilance system of monitoring, collecting, and evaluating data on adverse effects of blood transfusion locally and nationally will decrease the occurrence of acute transfusion reactions.
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Affiliation(s)
- Edosa Tadasa
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Misgana Bekele
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gebeyaw Arega
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lealem Gedefaw
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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2
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Acharya D, Gaussen A, Poder TG, Lambert G, Renaud C, Nawej K, Lewin A. Associated criteria used in investigating suspected septic transfusion reactions: A scoping review. Vox Sang 2023; 118:1029-1037. [PMID: 37691585 DOI: 10.1111/vox.13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Septic transfusion reactions (STRs) occur as a result of bacterial contamination of blood or blood products, resulting in sepsis. This scoping review aimed to identify, explore and map the available literature on the STR criteria triggering the investigation of STR. MATERIALS AND METHODS Four electronic databases (MEDLINE, Web of Science, Science Direct, Embase) were searched to retrieve scientific literature reporting such criteria, published from 1 January 2000 to 5 May 2022. Grey literature was also searched from open web sources. RESULTS Of 1052 references identified, 43 (21 peer-reviewed and 22 grey literature) met the eligibility criteria for inclusion and data extraction after full article screening. Of them, most (27/43, 62.79%) were found to report a single set of criteria, and only two reported four or more sets of criteria. The analysis of 66 sets of criteria collected from the selected references revealed 57 different sets. A few sets of criteria used only one sign and symptom (s/s) (12.12%, n = 8), whereas 16 sets used 7-15 s/s (n = 16/66; 24.24%). Of the total 319 occurrences of s/s associated with the 66 sets of criteria, post-transfusion hyperthermia, body temperature increase and hypotension were the most common s/s categories. Of all the literature available, only one study tested the diagnostic accuracy of the STR criteria. CONCLUSION This scoping review revealed a substantial variation in criteria used to identify suspected STR. Consequently, conducting further studies to enhance the diagnostic accuracy of these criteria, which trigger STR investigations, is imperative for advancing clinical practice.
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Affiliation(s)
- Dilaram Acharya
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Thomas G Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l'Est-de-L'île-de-Montréal, Montréal, Québec, Canada
| | - Gilles Lambert
- Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Karlitaj Nawej
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
- Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, Québec, Canada
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3
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Vassallo R, Kamel H, Goel R, Al-Riyami AZ, Al Muharrmi Z, Jacquot C, Ramirez-Arcos S, Khandelwal A, Goldman M, Hands K, McLintock L, Mitchell H, Wendel S, Scuracchio P, Fachini R, Pettersson SM, Bengtsson J, Brailsford SR, Tossell J, Amorim L, Lopes ME, Pêcego M, Germain M, Renaud C, Morley SL, So R, Townsend M, Hopkins C, Harritshoej LH, Erikstrup C, Gosbell IB, Levin MH, Dennington PM, Dunbar N. International Forum on Management of Blood Donors with Culture-Positive Platelet Donations: Summary. Vox Sang 2023; 118:997-1003. [PMID: 37772636 DOI: 10.1111/vox.13519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/30/2023]
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4
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Clifford V, Gonis G, Crighton G, Savoia H, Gosbell I, Daley AJ. Investigation for bacterial contamination of blood products implicated in suspected transfusion-transmitted bacterial infection. Pathology 2023; 55:153-155. [PMID: 35999076 DOI: 10.1016/j.pathol.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Vanessa Clifford
- Department of Laboratory Services, Royal Children's Hospital, Parkville, Vic, Australia; Murdoch Childrens Research Institute, Parkville, Vic, Australia; Australian Red Cross Lifeblood, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Gena Gonis
- Department of Laboratory Services, Royal Children's Hospital, Parkville, Vic, Australia
| | - Gemma Crighton
- Department of Laboratory Services, Royal Children's Hospital, Parkville, Vic, Australia
| | - Helen Savoia
- Department of Laboratory Services, Royal Children's Hospital, Parkville, Vic, Australia
| | - Iain Gosbell
- Australian Red Cross Lifeblood, Australia; Western Sydney University, Sydney, NSW, Australia
| | - Andrew J Daley
- Department of Laboratory Services, Royal Children's Hospital, Parkville, Vic, Australia; Murdoch Childrens Research Institute, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
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5
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Blood Transfusion Reactions-A Comprehensive Review of the Literature including a Swiss Perspective. J Clin Med 2022; 11:jcm11102859. [PMID: 35628985 PMCID: PMC9144124 DOI: 10.3390/jcm11102859] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 01/28/2023] Open
Abstract
Blood transfusions have been the cornerstone of life support since the introduction of the ABO classification in the 20th century. The physiologic goal is to restore adequate tissue oxygenation when the demand exceeds the offer. Although it can be a life-saving therapy, blood transfusions can lead to serious adverse effects, and it is essential that physicians remain up to date with the current literature and are aware of the pathophysiology, initial management and risks of each type of transfusion reaction. We aim to provide a structured overview of the pathophysiology, clinical presentation, diagnostic approach and management of acute transfusion reactions based on the literature available in 2022. The numbers of blood transfusions, transfusion reactions and the reporting rate of transfusion reactions differ between countries in Europe. The most frequent transfusion reactions in 2020 were alloimmunizations, febrile non-hemolytic transfusion reactions and allergic transfusion reactions. Transfusion-related acute lung injury, transfusion-associated circulatory overload and septic transfusion reactions were less frequent. Furthermore, the COVID-19 pandemic has challenged the healthcare system with decreasing blood donations and blood supplies, as well as rising concerns within the medical community but also in patients about blood safety and transfusion reactions in COVID-19 patients. The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy. Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system. The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments and fluid resuscitation.
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Acharya D, Lewin A, Gaussen A, Lambert G, Renaud C, Nawej K, Poder TG. Study protocol of associated criteria used in investigating septic transfusion reactions (STRs): A scoping review about available evidence. PLoS One 2022; 17:e0262765. [PMID: 35051241 PMCID: PMC8775533 DOI: 10.1371/journal.pone.0262765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background and objective Assessment criteria for septic transfusion reactions (STRs) are variable around the world. A scoping review will be carried out to find out, explore and map existing literature on STRs associated criteria. Methods This scoping review will include indexed and grey literatures available in English or French language from January 1, 2000, to December 31, 2021. Literature search will be conducted using four electronic databases (i.e., MEDLINE via PubMed, Web of Science, Science Direct, and Embase via Ovid), and grey literatures accompanying the research questions and objectives. Based on the inclusion criteria, studies will be independently screened by two reviewers for title, abstract, and full text. Extracted data will be presented in tabular form followed by a narrative description of inputs corresponding to research objectives and questions.
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Affiliation(s)
- Dilaram Acharya
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
- Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Gilles Lambert
- Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal du Québec, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
| | - Karlitaj Nawej
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Thomas G. Poder
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est-de-l’île-de-Montréal, Montréal, Canada
- * E-mail:
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7
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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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8
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Drews SJ, Lesley P, Detsky ME, Distefano L, Ilagan C, Mehta S, McGeer A, Shehata N, Skeate R, Ramirez-Arcos S. A suspected septic transfusion reaction associated with posttransfusion contamination of a platelet pool by vancomycin-resistant Enterococcus faecium. Transfusion 2019; 60:430-435. [PMID: 31859413 DOI: 10.1111/trf.15644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) are antibiotic-resistant organisms associated with both colonization and serious life-threatening infection in health care settings. Contamination of platelet concentrates (PCs) with Enterococcus can result in transfusion-transmitted infection. CASE PRESENTATION This report describes the investigation of a septic transfusion case involving a 27-year-old male patient with relapsed acute leukemia who was transfused with a 5-day-old buffy coat PC pool and developed fever and rigors. DISCUSSION Microbiology testing and pulse-field gel electrophoresis (PFGE) was done on patient blood cultures obtained from peripheral and central lines. Microbiology and molecular testing were also performed on the remaining posttransfusion PC pool, which was refrigerated for 24 hours before microbiology testing. Red blood cell (RBC) and plasma units associated with the implicated PCs were screened for microbial contamination. Patient blood cultures obtained from peripheral and central lines yielded vancomycin-resistant Enterococcus faecium. Gram stain of a sample from the platelet pool was negative but coagulase-negative Staphylococcus (CNST) and VRE were isolated on culture. Antibiotic sensitivity and PFGE profiles of several VRE isolates from the patient before and after transfusion, and the PC pool, revealed that all were closely related. Associated RBC and plasma components tested negative for microbial contamination. CONCLUSIONS Microbiological and molecular investigations showed a relationship between VRE isolated from the patient before and after transfusion, and therefore it is postulated that a patient-to-PC retrograde contamination (from either blood or skin) occurred. As the CNST isolated from the PC pool was not isolated from patient samples, its implication in the transfusion event is unknown.
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Affiliation(s)
- Steven J Drews
- Canadian Blood Services, Edmonton, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Lesley
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Michael E Detsky
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sangeeta Mehta
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allison McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Robert Skeate
- Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Sandra Ramirez-Arcos
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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9
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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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10
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Desroches M, Clermont O, Lafeuillade B, Rodriguez C, Darty M, Royer G, Bouvet O, Ounnoughene N, Noizat-Pirenne F, Denamur E, Decousser JW. Genotypic and phenotypic characteristics of Escherichia coli involved in transfusion-transmitted bacterial infections: implications for preventive strategies. Transfusion 2019; 58:1940-1950. [PMID: 30198609 DOI: 10.1111/trf.14812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/05/2018] [Accepted: 04/09/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Transfusion-transmitted bacterial infections (TTBIs) are the main residual infectious complications of transfusions. Escherichia coli and platelet (PLT) concentrates may be epidemiologically associated, leading to severe, if not lethal, TTBIs. We investigated the genotypic and phenotypic reasons for this clinically deleterious combination. STUDY DESIGN AND METHODS We investigated a French national E. coli strain collection related to six independent episodes of TTBIs. Their phenotypic characterizations included antibiotic susceptibility testing, growth testing under different culture conditions, serum survival assays, and virulence in a sepsis mouse model. Their genotypic characterizations included polymerase chain reaction phylotyping, whole genome sequencing, and a subsequent in silico analysis. RESULTS We highlighted a selection process of highly extraintestinal virulent strains, mainly belonging to the B2 phylogroup, adapted to the hostile environment (high citrate concentration and a bactericidal serum effect) of apheresis-collected platelet concentrates (PCs). Compared to controls, the E. coli TTBI strains grew faster in the PCs due to a superior ability to capture iron. The in vitro growth performances were highly compatible with blood-derived product real-life conditions, including storage conditions and delays. The consistent serum resistance of TTBI strains promotes their survival in both the donor's and the receiver's blood and in the PCs. CONCLUSION This study pointed out that E. coli strains responsible for TTBI exhibit very specific traits. They belong to the extraintestinal pathogenic phylogroups and have a high intrinsic virulence. They can be resistant to complement, capture iron, and grow in the apheresis-collected PCs. These findings therefore support the reinforcement of the postdonation information.
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Affiliation(s)
- Marine Desroches
- INSERM UMR1137, IAME, Paris Diderot University, Faculty of Medicine Xavier Bichat, Paris, France.,Department of Bacteriology and Infection Control, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Olivier Clermont
- INSERM UMR1137, IAME, Paris Diderot University, Faculty of Medicine Xavier Bichat, Paris, France
| | - Bruno Lafeuillade
- Rhône-Alpes French Blood Establishment-Grenoble Site, La Tronche, France
| | - Christophe Rodriguez
- Next Generation Sequencing Platform, University Hospital Henri Mondor, Créteil, France
| | - Mélanie Darty
- Next Generation Sequencing Platform, University Hospital Henri Mondor, Créteil, France
| | - Guilhem Royer
- INSERM UMR1137, IAME, Paris Diderot University, Faculty of Medicine Xavier Bichat, Paris, France.,Department of Bacteriology and Infection Control, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Odile Bouvet
- INSERM UMR1137, IAME, Paris Diderot University, Faculty of Medicine Xavier Bichat, Paris, France
| | | | | | - Erick Denamur
- INSERM UMR1137, IAME, Paris Diderot University, Faculty of Medicine Xavier Bichat, Paris, France.,Department of Molecular Genetics, University Hospital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Winoc Decousser
- INSERM UMR1137, IAME, Paris Diderot University, Faculty of Medicine Xavier Bichat, Paris, France.,Department of Bacteriology and Infection Control, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
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11
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Haass KA, Sapiano MRP, Savinkina A, Kuehnert MJ, Basavaraju SV. Transfusion-Transmitted Infections Reported to the National Healthcare Safety Network Hemovigilance Module. Transfus Med Rev 2019; 33:84-91. [PMID: 30930009 DOI: 10.1016/j.tmrv.2019.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
Transfusion-transmitted infections (TTIs) can be severe and result in death. Transfusion-transmitted viral pathogen transmission has been substantially reduced, whereas sepsis due to bacterial contamination of platelets and transfusion-transmitted babesiosis may occur more frequently. Quantifying the burden of TTI is important to develop targeted interventions. From January 1, 2010, to December 31, 2016, health care facilities participating in the National Healthcare Safety Network Hemovigilance Module monitored transfusion recipients for evidence of TTI and recorded the total number of units transfused. Facilities use standard criteria to report TTIs. Incidence rates of TTIs, including for bacterial contamination of platelets and transfusion-transmitted babesiosis, are presented. One hundred ninety-five facilities reported 111 TTIs and 7.9 million transfused components to the National Healthcare Safety Network Hemovigilance Module. Of these 111 reports, 54 met inclusion criteria. The most frequently reported pathogens were Babesia spp in RBCs (16/23, 70%) and Staphylococcus aureus in platelets (12/30, 40%). There were 1.95 (26 apheresis, 4 whole blood derived) TTIs per 100 000 transfused platelet units and 0.53 TTI per 100 000 transfused RBC components, compared to 0.68 TTI per 100 000 all transfused components. Bacterial contamination of platelets and transfusion-transmitted babesiosis were the most frequently reported TTIs. Interventions that reduce the burden of bacterial contamination of platelets, particularly collected by apheresis, and Babesia transmission through RBC transfusion would reduce transfusion recipient morbidity and mortality. These analyses demonstrate the value and importance of facility participation in national recipient hemovigilance using standard reporting criteria.
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Affiliation(s)
- Kathryn A Haass
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention.
| | - Mathew R P Sapiano
- Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention
| | - Alexandra Savinkina
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention; Oak Ridge Institute for Science and Education
| | - Matthew J Kuehnert
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Sridhar V Basavaraju
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
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12
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Ainley LI, Hewitt PE. Haematology patients and the risk of transfusion transmitted infection. Br J Haematol 2018; 180:473-483. [DOI: 10.1111/bjh.15030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Louise I. Ainley
- Department of Haematology; Imperial College Healthcare NHS Trust; London UK
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13
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Benjamin RJ, Braschler T, Weingand T, Corash LM. Hemovigilance monitoring of platelet septic reactions with effective bacterial protection systems. Transfusion 2017; 57:2946-2957. [PMID: 28840603 DOI: 10.1111/trf.14284] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/01/2017] [Accepted: 07/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Delayed, large-volume bacterial culture and amotosalen/ultraviolet-A light pathogen reduction are effective at reducing the risk of bacterial proliferation in platelet concentrates (PCs). Hemovigilance programs continue to receive reports of suspected septic transfusion reactions, most with low imputability. Here, we compile national hemovigilance data to determine the relative efficacy of these interventions. STUDY DESIGN AND METHODS Annual reports from the United Kingdom, France, Switzerland, and Belgium were reviewed between 2005 and 2016 to assess the risk of bacterial contamination and septic reactions. RESULTS Approximately 1.65 million delayed, large-volume bacterial culture-screened PCs in the United Kingdom and 2.3 million amotosalen/ultraviolet-A-treated PCs worldwide were issued with no reported septic fatalities. One definite, one possible, and 12 undetermined/indeterminate septic reactions and eight contaminated "near misses" were reported with delayed, large-volume bacterial cultures between 2011 and 2016, for a lower false-negative culture rate than that in the previous 5 years (5.4 vs. 16.3 per million: odds ratio, 3.0; 95% confidence interval, 1.4-6.5). Together, the Belgian, Swiss, and French hemovigilance programs documented zero probable or definite/certain septic reactions with 609,290 amotosalen/ultraviolet-A-treated PCs (<1.6 per million). The rates were significantly lower than those reported with concurrently transfused, nonpathogen-reduced PCs in Belgium (<4.4 vs. 35.6 per million: odds ratio, 8.1; 95% confidence interval,1.1-353.3) and with historic septic reaction rates in Switzerland (<6.0 vs. 82.9 per million: odds ratio, 13.9; 95% confidence interval, 2.1-589.2), and the rates tended to be lower than those from concurrently transfused, nonpathogen-reduced PCs in France (<4.7 vs. 19.0 per million: odds ratio, 4.1; 95% confidence interval, 0.7-164.3). CONCLUSION Pathogen reduction and bacterial culture both reduced the incidence of septic reactions, although under-reporting and strict imputability criteria resulted in an underestimation of risk.
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Affiliation(s)
| | | | - Tina Weingand
- Blutspendedienst Zentralschweiz SRK, Luzern, Switzerland
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14
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Martini R, Hörner R, Graichen DÂS. Antimicrobial susceptibility profile and research of mec A and erm genes in coagulase-negative staphylococci isolated from platelet concentrates bags. BRAZ J PHARM SCI 2017. [DOI: 10.1590/s2175-97902017000115195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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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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16
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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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17
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Ramirez-Arcos S, Alport T, Goldman M. Intermittent bacteremia detected in an asymptomatic apheresis platelet donor with repeat positive culture forEscherichia coli: a case report. Transfusion 2015; 55:2606-8. [DOI: 10.1111/trf.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | - Ted Alport
- Canadian Blood Services; Ottawa Ontario Canada
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18
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Eder AF, Goldman M. Postdonation Information and Blood Component Retrievals: Realigning Blood Center and Hospital Actions Based on Risk Assessment. Transfus Med Rev 2014; 28:226-34. [DOI: 10.1016/j.tmrv.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/12/2023]
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19
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McDonald C. Bacterial testing of platelet components: is there added benefit for our donors? Transfusion 2013; 53:2117-9. [DOI: 10.1111/trf.12385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carl McDonald
- National Bacteriology Laboratory; NHS Blood and Transplant; Colindale UK
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20
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Christensen RD, Ilstrup S. Recent advances toward defining the benefits and risks of erythrocyte transfusions in neonates. Arch Dis Child Fetal Neonatal Ed 2013; 98:F365-72. [PMID: 22751184 DOI: 10.1136/archdischild-2011-301265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Like many treatments available to small or ill neonates, erythrocyte transfusions carry both benefits and risks. This review examines recent publications aimed at better defining those benefits and those risks, as means of advancing evidence-based neonatal intensive care unit transfusion practices. Since decisions regarding whether to not to order an erythrocyte transfusion are based, in part, on the neonate's blood haemoglobin concentration, the authors also review recent studies aimed at preventing the haemoglobin from falling to a point where a transfusion is considered.
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21
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Lee C, Chan H, Ho P, Wong H, Leung J, Tsoi W, Lin C. Long-term clinical outcomes afterStreptococcus bovisisolation in asymptomatic blood donors in Hong Kong. Transfusion 2013; 53:2207-10. [DOI: 10.1111/trf.12087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/17/2012] [Accepted: 11/18/2012] [Indexed: 12/24/2022]
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22
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Two septic transfusion reactions presenting as transfusion-related acute lung injury from a split plateletpheresis unit. Crit Care Med 2012; 40:2488-91. [PMID: 22809916 DOI: 10.1097/ccm.0b013e3182544f85] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We report two simultaneous cases of Staphylococcus aureus sepsis initially consistent with and diagnosed as transfusion-related acute lung injury. The sepsis in both cases resulted from transfusion of two split products from a single contaminated plateletpheresis unit. In each case, the platelets were given along with numerous other blood products during posterior spine surgery. The discussion includes presentation, clinical course, diagnosis, and similarities between sepsis and transfusion-related acute lung injury. The cases and discussion highlight the importance of considering sepsis as part of the differential for any patient believed to have transfusion-related acute lung injury with clinical features of sepsis. DATA SOURCES Data were collected from the patients' electronic medical records and the hospital laboratory medicine database. CONCLUSIONS Our cases highlight the importance of vigilant investigation in patients suspected of transfusion-related acute lung injury, as septic transfusions are easily missed and may mimic or coexist with transfusion-related acute lung injury. Sepsis should be strongly considered whenever clinical features such as hypotension, leucopenia, and fever are noted in patients with suspected transfusion-related acute lung injury. In comparison to patients receiving red blood cells or plasma, platelet transfusion recipients are at a greater risk for sepsis from a contaminated unit. Patients developing sepsis from a contaminated blood product may meet the clinical definition of transfusion-related acute lung injury. In such cases, if the clinical syndrome is attributed solely to transfusion-related acute lung injury and bacterial sepsis is not suspected, the correct diagnosis may be missed or delayed. Consequently, appropriate treatment for sepsis would also be delayed or not provided and likely result in increased morbidity and mortality.
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23
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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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