Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
Crit Care. 2018 Oct 27;22(1):271. doi: 10.1186/s13054-018-2212-9.
Platelet transfusions carry greater risks of infection, sepsis, and death than any other blood product, owing primarily to bacterial contamination. Many patients may be at particular risk, including critically ill patients in the intensive care unit. This narrative review provides an overview of the problem and an update on strategies for the prevention, detection, and reduction/inactivation of bacterial contaminants in platelets. Bacterial contamination and septic transfusion reactions are major sources of morbidity and mortality. Between 1:1000 and 1:2500 platelet units are bacterially contaminated. The skin bacterial microflora is a primary source of contamination, and enteric contaminants are rare but may be clinically devastating, while platelet storage conditions can support bacterial growth. Donor selection, blood diversion, and hemovigilance are effective but have limitations. Biofilm-producing species can adhere to biological and non-biological surfaces and evade detection. Primary bacterial culture testing of apheresis platelets is in routine use in the US. Pathogen reduction/inactivation technologies compatible with platelets use ultraviolet light-based mechanisms to target nucleic acids of contaminating bacteria and other pathogens. These methods have demonstrated safety and efficacy and represent a proactive approach for inactivating contaminants before transfusion to prevent transfusion-transmitted infections. One system, which combines ultraviolet A and amotosalen for broad-spectrum pathogen inactivation, is approved in both the US and Europe. Current US Food and Drug Administration recommendations advocate enhanced bacterial testing or pathogen reduction/inactivation strategies (or both) to further improve platelet safety. Risks of bacterial contamination of platelets and transfusion-transmitted infections have been significantly mitigated, but not eliminated, by improvements in prevention and detection strategies. Regulatory-approved technologies for pathogen reduction/inactivation have further enhanced the safety of platelet transfusions. Ongoing development of these technologies holds great promise.
血小板输注比任何其他血液制品都具有更大的感染、败血症和死亡风险，主要是由于细菌污染。许多患者可能面临特别的风险，包括重症监护病房的危重症患者。本叙述性综述提供了该问题的概述，并更新了预防、检测和减少/灭活血小板中细菌污染物的策略。细菌污染和脓毒症输血反应是发病率和死亡率的主要原因。在 1:1000 到 1:2500 个血小板单位中存在细菌污染。皮肤细菌菌群是污染的主要来源，而肠源性污染物很少见，但可能具有临床破坏性，而血小板储存条件可以支持细菌生长。供者选择、血液分流和血液监测是有效的，但存在局限性。产生物膜的物种可以附着在生物和非生物表面上并逃避检测。美国常规使用对单采血小板进行初级细菌培养检测。与血小板兼容的病原体减少/灭活技术使用基于紫外线的机制来靶向污染细菌和其他病原体的核酸。这些方法已被证明是安全有效的，代表了在输血前主动灭活污染物以预防输血传播感染的方法。一种结合紫外线 A 和氨甲喋呤的方法用于广谱病原体灭活，已分别在美国和欧洲获得批准。目前美国食品和药物管理局的建议主张增强细菌检测或病原体减少/灭活策略（或两者兼而有之），以进一步提高血小板的安全性。通过改进预防和检测策略，血小板污染和输血传播感染的风险已得到显著缓解，但尚未消除。经监管部门批准的病原体减少/灭活技术进一步提高了血小板输注的安全性。这些技术的不断发展具有巨大的前景。
