AABB recommendations for detecting platelet infections

AABB recommendations for detecting platelet infections

Three scenarios outlined

It is critical that clinicians are aware of the problem of bacterial contamination of blood components, particularly platelets, and consider the possibility of bacterial contamination when investigating transfusion reactions, the American Association of Blood Banks (AABB) is urging.¹ The AABB offers the following evaluation and management recommendations to address the three most common situations clinicians may face:

1. The clinician is contacted with information involving bacterial contamination of a blood component after it has been transfused.
2. A recipient develops post-transfusion bacteremia after receiving platelets.
3. A blood donor is identified as possibly infected and referred to a clinician for medical follow-up.

1. The clinician is contacted by the blood collection facility or transfusion service with information involving blood or a blood component with bacterial contamination after it has been transfused.
   1. The minimal evaluation of a patient suspected of having received a bacterially contaminated platelet transfusion should include:
      • Culture of any residual component, if available, to confirm the initial result.
      • Blood cultures of the patient, even in the absence of apparent sepsis, to be certain that clinically silent infections are not missed.
   2. Any isolates (i.e., microorganisms obtained from the residual component and/or patient cultures) should be retained until the case investigation is completed. This permits detailed studies to determine if the micro-organisms are linked.
   3. Results of the patient’s clinical and laboratory work-up should be promptly communicated to the transfusion service medical director, who, in turn, should report these findings to the collection facility; these data will help determine the significance of the platelet test result.
   
   
   
2. A blood or blood component recipient has signs or symptoms consistent with posttransfusion bacteremia. Because no test is 100% sensitive, false-negative results of platelet screening for bacterial contamination will occur.
   1. Transfusing physicians should continue to evaluate all transfused patients with onset of signs or symptoms consistent with bacteremia or sepsis for post-transfusion bacterial infection, even when a bacterially tested component has been infused.
   2. The minimal evaluation of a patient with suspected sepsis following platelet transfusion should include the following:
      • Culture of any residual component, if available.
      • Blood cultures of the patient.
   3. Any isolates (i.e., microorganisms obtained from the residual component and/or patient cultures) should be retained until the case investigation is completed. This permits detailed studies to determine if the micro-organisms are linked.
   4. Results of the patient’s clinical and laboratory work-up should be promptly communicated to the transfusion service medical director, who, in turn, should report these findings to the collection facility; these data will help determine the significance of the initially negative test result.
   
   
3. A blood donor presents to a clinician with a report of possible infection with bacteria discovered during the blood donation process.
   1. Donors with potentially medically significant microorganisms may be advised by the collection facility to see their physician for further evaluation. Evaluation of the donor by the physician should begin with a thorough clinical history and a physical examination. Follow-up investigations might include blood cultures, other body-site cultures, and additional tests as appropriate.
   2. Communication between the blood center physician and the clinician should facilitate management of the donor. Identification of a culture indicating endogenous bacteremia will likely result in deferral of the donor from future blood donation. To resume donation, the blood collection facility may require the donor to be cleared by the clinician and the blood center medical director; this reentry could be based on the donor successfully completing treatment.

Reference

1. AABB Bacterial Contamination Task Force. Bacterial Contamination of Platelets: Summary for Clinicians on Potential Management Issues Related to Transfusion Recipients and Blood Donors. Feb. 23, 2005. Web: www.aabb.org/Pressroom/In_the_News/bactcontplat022305.htm.