Bacterial Contamination of Platelet Units: A Case Report and Literature Survey With Review of Upcoming American Association of Blood Banks Requirements

Abstract

Abstract The most common transfusion-associated infectious risk in the United States today is bacterial contamination of platelet components. Bacterial contamination is estimated to occur at an incidence of 1:1000 to 1:3000 in platelet units, with severe episodes estimated to occur in about one sixth of contaminated products. Increased awareness and prompt reaction of the medical team can greatly affect the outcome and save a patient's life. The following case history illustrates this issue. A young woman developed chills and rigors while receiving 1 unit of leuko-reduced apheresis platelets for severe thrombocytopenia. The transfusion was stopped, blood cultures were drawn, and the patient developed clinical signs of sepsis. Cultures of both the platelet unit and the patient's blood revealed coagulase-negative Staphylococcus. Microbial susceptibilities in both samples were identical. Pretransfusion blood cultures taken from the patient earlier that day were negative. The platelet unit had been stored for 5 days. We review this case and the literature describing the persistent problem of platelet unit contamination and at the same time highlight the efforts now directed by the American Association of Blood Banks and College of American Pathologists to address this issue. Although there is no uniform approach to dealing with bacterial contamination of platelets, the American Association of Blood Banks and the College of American Pathologists have promulgated new accreditation requirements in an effort to prevent bacterial sepsis associated with platelet transfusion. A new American Association of Blood Banks standard, which will be effective March 1, 2004, requires a combination of strategies both to limit the initial inoculation of bacteria into the blood component and to detect subsequent growth at room temperature (American Association of Blood Banks Association Bulletin #03-12). The new College of American Pathologists Checklist question, which became effective in December 2003, is a Phase 1 requirement that calls for inspected facilities to have a platelet bacteria detection method in place.