When to suspect this adverse reaction?
Clinical features suggesting the possibility of bacterial contamination and/or endotoxin reaction may include rigors, high fever, severe chills, hypotension, tachycardia, nausea and vomiting, dyspnoea, or circulatory collapse during or soon after transfusion.
In severe cases, the patient may develop shock with accompanying renal failure and disseminated intravascular coagulation (DIC) (2). This reaction may be fatal.(1,2)
In Australia clinically apparent reactions due to bacterial infections are reported in approximately 1:250 000 platelet transfusions and approximately 1:2.5 million red cell transfusions.(3)
Bacterial infection is more common with:
- platelets (as these are stored at room temperature)
- previously frozen components thawed by immersion in a water bath
- red cell components stored for several weeks
Blood components may be contaminated by:(1)
- Bacteria from the donor’s skin during the collection procedure
- Unrecognised bacteraemia in the donor
- Contamination from the environment
- Contamination during the preparation of components
- Contamination of ports during the thawing of frozen products in a water bath
Both gram-positive and gram-negative organisms have been implicated in transfusion transmitted bacterial infection with serious morbidity and mortality occurring most frequently with gram-negative bacteria.(1)
Organisms capable of multiplying at low temperatures and those using iron as a nutrient are most often associated with red cell contamination, especially Yersinia enterocolitica.(4)
Request for blood cultures from the patient, and perform culture and Gram Stain on the remainder of the blood component.
The key to diagnosing transfusion related sepsis is culturing the same organism from the patient and component.
Keep the blood bag and giving set (sealed) for further investigation.
What to do?
Stop transfusion immediately and follow other steps for managing suspected transfusion reactions. Seek urgent medical assistance as this may become an emergency.
Start broad-spectrum antibiotics once cultures have been taken.
Provide cardiorespiratory support.
Send blood pack to the Transfusion Service Provider for urgent culture and Gram Stain
Advise Transfusion Service Provider to notify the Blood Service to ensure quarantining and testing of related components from the same donation/donor.
- Callum JL, Pinkerton PH, Lima A, Lin Y, Karkouti K, Lieberman, L, et al. Chapter 5, Transfusion Reactions. Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 4rd edition. Canada: Ontario Regional Blood Coordinating Network, 2016.
- Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 18th edition. AABB, Bethesda, 2014.
- Thyer J, Perkowska-Guse Z, Ismay SL, Keller AJ, Chan HT, Dennington PM, et al. Bacterial testing of platelets - has it prevented transfusion-transmitted bacterial infections in Australia? Vox Sang 2018; 113: 13-20.
- Guinet F, Carniel E, Leclercq A. Transfusion-Transmitted Yersinia enterocolitica sepsis. Clin Infect Dis 2011;53(6):583-591.