Transfusion: Bacterial sepsis

Transfusion transmitted bacterial infection (TTBI) is an important complication of blood product administration. A wide spectrum of organisms has been associated with transfusion transmitted bacterial infection, including skin, enteric, and environmental organisms. Gram-negative rods have been observed more frequently as red blood cell contaminants, while gram-positive organisms have been observed more frequently as platelet contaminants.

Estimates of TTBI incidence are variable due to differences in definitions used and the means of reporting suspected cases. In addition, the risk varies with the type of blood product and the underlying conditions(s) of patient transfused. Platelet transfusions carry a higher risk of contamination because they are stored at room temperature.

Clinical manifestations of transfusion transmitted bacterial infection include fever, rigors, tachycardia, and rise or fall in systolic blood pressure. Distinguishing between TTBI and other conditions on these grounds is unreliable, however, since these manifestations can also be associated with nonhemolytic transfusion reactions, acute hemolytic reactions, allergic reactions and other causes. In addition, TTBI can also occur in the absence of these findings.

In the setting of suspected TTBI, the transfusion should be stopped, the patient should be resuscitated and blood should be collected for culture and evaluation for evidence of transfusion reaction. The blood bank and microbiology laboratory should be alerted; checks for clerical error should be performed, and the blood product bag should be sent for culture. If suspicion for TTBI is high (eg, in the setting of fever together with hypotension, shock, or respiratory failure), we suggest initiating broad spectrum empiric antibiotic therapy; reasonable regimens include vancomycin plus a beta-lactam or an aminoglycoside. Antibiotic therapy should be adjusted based on culture results, or discontinued if an alternate diagnosis is made.

The common preventive strategies include donor selection protocol, skin disinfection, sample diversion, leukodepletion, and detection of contamination by culture.