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BACTERIAL CONTAMINATION.

PREPARED BY: RAITHA R SULEIMAN

1
ALEXANDRIA UNIVERSITY
2018.
 INTRODUCTION.
• Blood transfusion is a key component of modern
day health care and therefore it is of utmost
importance to ensure that blood and blood
products meet the appropriate national standards
of safety and efficacy for transfusion and benefit
blood recipients in their clinical management
process.

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 • Bacterially contaminated components continue to
be a potentially fatal risk of transfusion.
• Fatality from a bacterially contaminated platelet
unit, at 7/million units, is 20X > risk of HIV
transmission.
• Fatality from a bacterially contaminated RBC unit,
at 1/million units, also exceeds the HIV
transmission rate.

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TRANSFUSION-TRANSMITTED BACTERIAL INFECTION OF
PLATELET.
• Bacterial growth in RBC more in room temp but less in
refrigerated red cell unit storage supports bacterial growth less
well.
• Plt bacterial contamination is estimated at 1 in 2,000 units.
• Plt Severe septic reaction is estimated at 1 in 50,000 units.
• The majority of contaminants are G+ve bacteria (Staphylococcus
species) introduced during phlebotomy at the time of donation.
• G-ve bacteria: more serious and life threating conditionts.

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 TRANSFUSION-TRANSMITTED BACTERIAL INFECTION OF RBC.
• Sepsis a very rare event. one red cell-related death per year has been reported.
• The majority of deaths reported to the FDA involved Yersinia enterocolitica.
• Sepsis associated with with G-ve bacteria is severe and rapid in onset.
• Patients frequently develop:
1. high fever (temp as high as 109°F)
2. chills during or immediately after transfusion.
• The bacterial cultures of whole blood or red cells have shown a much higher
incidence of bacterial contamination (2 to 4/1,000 units).
• however, the organisms commonly cultured are Staphylococcus or
Propionibacterium spp.,which generally proliferate poorly during storage at 1
to 6°C.

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TRANSFUSION-TRANSMITTED BACTERIAL INFECTION OF PLASMA AND
CRYOPRECIPITATE.
• Plasma and cryoprecipitate are stored frozen are rarely
associated with contamination.
• However, in some cases Pseudomonas cepacia and P.
aeruginosa have been cultured from cryoprecipitate
and plasma thawed in contaminated water baths.

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SOURCES OF CONTAMINATION.
• Most commonly, contamination occurs during;
A) Blood collection (insufficient disinfection of venepuncture site).
G+ve skin commensals such as Staphylococcus epidermidis and Bacillus cereus
are the organisms most often recovered from donated blood (and implicated in
bacterial contamination of platelets).
Such contamination is thought to occur principally during phlebotomy, as a result
of incomplete disinfection and/or skin core removal by the collection needle.
b) From an asymptomatic donor bacteremia.
In the case of G-ve bacterial contamination, asymptomatic donors with transient
bacteremia are presumed to be responsible for most cases of contamination.
c) During handling of blood products (leaky seals).

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CLINICAL PRESENTATION. (temp- PR- BP)
i. Fever (>102º F (38.9), or a >3.6º F increase from the pretransfusion
baseline)

ii. Rigors

iii. Chills and fever are the most commonly reported symptoms.

iv. Tachycardia, or an increase in heart rate by more than 40 beats per

minute from the baseline

v. Fall of sys BP of > 30 mmHg are highly suggestive of the condition.

vi. Other clues include backache, abdominal pain, vomiting, and

hypothermia.

vii. Complications may reach sepsis and death

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 Management.
1- Stop transfusion.

2- Aggressive rehydration.

3- Recheck for blood matching , sample for blood culture

from donor & recipient.

4- Empiric antibiotics till time of isolation. ‫لحد ما نعزل العيان‬

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METHODS TO REDUCE THE RISK OF POSTTRANSFUSION
SEPSIS.
• There are multiple strategies to reduce transfusion-related
bacterial infection.
• The various approaches can be grouped into 4 major
categories:
1. Avoidance, these includes:
I. To reduce asymptomatic donor bacteremia( subjects with
recent dental treatments, minor surgery),
II. Skin preparation by Improved donor arm disinfection,
III. Removal of the initial whole blood collection
(diversion)(the first 30–40 ml of whole blood from the
collection bag might reduce the contamination risk from
skin bacteria),
IV. Optimal product processing: handling and storage.

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 2) Bacterial detection: including an
i. Automated bacterial culture method (BacT/ALERT system,
bioMérieux),
ii. Direct bacterial staining,
iii. Bacterial endotoxin and ribosomal assays,
iv. Nucleic acids testing for bacterial DNA, and
v. Measures of O2 consumption or CO2 production (Pall BDS, Pall
Corporation) .
3) Bacterial elimination: (by pathogen reduction technologies e.g.
i. methylene blue (MB) and
ii. solvent-detergent (SD),the
iii. photochemical treatment (PCT) with amotosalen and UVA light
can be used for FFP and platelets ) , and
4) Growth inhibition: By + of antibiotics to blood components (but
has not been adopted due to the added risk of drug reactions and
antibiotic resistance).

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