Department of Pathology and Laboratory Medicine, Wake Forest University School of Medicine Winston-Salem, Winston-Salem, North Carolina, USA.
American National Red Cross, Washington, District of Columbia, USA.
Transfusion. 2021 Feb;61(2):641-648. doi: 10.1111/trf.16210. Epub 2020 Dec 8.
Pathogen reduction technology and enhanced bacterial culture screening promise to significantly reduce the risk of transfusion-associated septic reactions due to contaminated platelets. Recent reports suggest that these interventions lack efficacy for post-collection and processing contamination with environmental organisms if the storage bag integrity is compromised.
We report a fatal septic transfusion reaction in a 63-year-old patient with chronic kidney and liver disease who received a pathogen reduced platelet transfusion in anticipation of surgery.
The residual platelet concentrate was cultured, with the detected microorganisms undergoing 16S genotype sequencing. Separate pathogen reduction studies were performed on the recovered bacteria, including assessment for amotosalen photoproducts. The storage container was subjected to pressure testing and microscopic examination. Environmental culture screening was performed at the hospital.
Gram negative rods were detected in the platelet unit and cultures of both platelet component and the patient's blood grew Acinetobacter baumannii complex, Leclercia adecarboxylata and Staphylococcus saprophyticus. These strains were effectively inactivated with >7.2, 7.7, and >7.1 log kill, respectively. The platelet storage container revealed a leak visible only on pressure testing. Hospital environmental cultures were negative and the contamination source is unknown. A. baumannii complex and S. saprophyticus 16S genotyping sequences were identical to those implicated in a previously reported septic reaction.
Findings are compatible with post-processing environmental contamination of a pathogen reduced platelet concentrate via a non-visible, acquired storage container leak. Efforts are warranted to actively prevent damage to, and detect defects in, platelet storage containers, and to store and transport components in clean environments.
病原体减少技术和增强的细菌培养筛选有望显著降低因污染血小板而导致的输血相关败血症反应的风险。最近的报告表明，如果储存袋完整性受损，这些干预措施对于收集后和处理过程中与环境生物的污染缺乏效果。
我们报告了一例 63 岁慢性肾病和肝病患者在手术前接受病原体减少血小板输血后发生致命性输血相关败血症反应的病例。
对剩余的血小板浓缩物进行培养，对检测到的微生物进行 16S 基因型测序。对回收的细菌分别进行病原体减少研究，包括评估氨基多杀菌素光产物。对储存容器进行压力测试和显微镜检查。在医院进行环境培养筛选。
在血小板单位中检测到革兰氏阴性杆菌，血小板成分和患者血液的培养均生长出鲍曼不动杆菌复合体、莱克氏柠檬酸杆菌和腐生葡萄球菌。这些菌株分别用 >7.2、7.7 和 >7.1 对数杀灭有效灭活。血小板储存容器仅在压力测试时显示可见泄漏。医院环境培养物呈阴性，污染源未知。A. baumannii 复合体和 S. saprophyticus 16S 基因分型序列与先前报告的败血症反应中涉及的序列相同。
这些发现与病原体减少血小板浓缩物通过可见的、获得的储存容器泄漏进行收集后环境污染相符。有必要努力积极防止血小板储存容器的损坏和缺陷，并在清洁环境中储存和运输成分。
