Erony Sean M, Marshall Christi E, Gehrie Eric A, Boyd Joan S, Ness Paul M, Tobian Aaron A R, Carroll Karen C, Blagg Lorraine, Shifflett Lisa, Bloch Evan M
Johns Hopkins Hospital and Medical Institutions, Baltimore, Maryland.
Transfusion. 2018 Aug;58(8):1933-1939. doi: 10.1111/trf.14789. Epub 2018 Aug 28.
Bacterial contamination and associated septic transfusion reactions (STRs) remain the leading infectious risk to the blood supply. We sought to characterize the risk and clinical presentation of blood culture-positive transfusion reactions (BCPTRs) and STRs at our institution.
A retrospective analysis was conducted of all suspected transfusion reactions reported to the transfusion service at a 1000-bed tertiary academic medical center from January 2009 to September 2016. Routine investigation included review of the clinical presentation, Gram stain, and bacterial culture of residual blood from the transfused product or associated blood bag. BCPTRs were defined by the presence of a positive bacterial culture in the blood product and/or recipient. STRs met definitive Centers for Disease Control and Prevention hemovigilance criteria for transfusion-transmitted infection, with definite imputability and concordant bacterial culture of the blood product and recipient.
A total of 688,514 blood products were transfused during the study period, 3170 transfusion reactions were reported, and 18 (0.57%) were BCPTRs of which seven (0.22%) were STRs. Fifteen of 18 (83.3%) BCPTRs and six of seven (85.7%) were associated with transfusion of apheresis platelets. Major symptoms and signs of BCPTRs included chills (67%), fever (61%), and nausea and vomiting (50%). Four of seven (57.1%) STRs were classified as severe or life-threatening.
BCPTRs are rare yet potentially serious. The signs and symptoms of BCPTRs, and associated STRs, are not specific, posing risk of misclassification. Challenges surrounding reporting and case ascertainment underscore the need for laboratory measures to address residual risk of contamination.
细菌污染及相关的败血症性输血反应（STRs）仍然是血液供应面临的主要感染风险。我们试图描述我院血培养阳性输血反应（BCPTRs）和STRs的风险及临床表现。
对2009年1月至2016年9月期间，一所拥有1000张床位的三级学术医疗中心输血科报告的所有疑似输血反应进行回顾性分析。常规调查包括对临床表现、革兰氏染色以及输注产品或相关血袋中残留血液的细菌培养进行审查。BCPTRs定义为血液制品和/或受血者的细菌培养呈阳性。STRs符合疾病控制与预防中心输血传播感染的确切监测标准，具有明确的可归因性，且血液制品和受血者的细菌培养结果一致。
在研究期间共输注了688,514单位血液制品，报告了3170例输血反应，其中18例（0.57%）为BCPTRs，7例（0.22%）为STRs。18例BCPTRs中有15例（83.3%）以及7例STRs中有6例（85.7%）与单采血小板输注有关。BCPTRs的主要症状和体征包括寒战（67%）、发热（61%）以及恶心和呕吐（50%）。7例STRs中有4例（57.1%）被归类为严重或危及生命。
BCPTRs虽罕见但可能很严重。BCPTRs以及相关STRs的体征和症状不具有特异性，存在分类错误的风险。报告和病例确定方面的挑战凸显了采取实验室措施以应对残留污染风险的必要性。
