Chiu E K, Yuen K Y, Lie A K, Liang R, Lau Y L, Lee A C, Kwong Y L, Wong S, Ng M H, Chan T K
Department of Medicine, Queen Mary Hospital, University of Hong Kong.
Transfusion. 1994 Nov-Dec;34(11):950-4. doi: 10.1046/j.1537-2995.1994.341195065031.x.
The danger of bacteremia due to contaminated platelets is not well known. There are also no established guidelines for the management of febrile reactions after platelet transfusion.
To determine the risk of symptomatic bacteremia after platelet transfusion, 3584 platelet transfusions given to 161 patients after bone marrow transplantation were prospectively studied. Platelet bags were routinely refrigerated for 24 hours after transfusion. Septic work-up was initiated for a temperature rise of more than 2 degrees C above the pretransfusion value within 24 hours of platelet transfusion or a temperature rise of more than 1 degree C that was associated with chills and rigor. Diagnosis of bacteremia after platelet transfusion was made only when the pairs of isolates from the blood and the platelet bags were identical with respect to their biochemical profile, antibiotic sensitivity, serotyping, or ribotyping.
Thirty-seven febrile reactions, as defined above, occurred. Bacteremia subsequent to platelet transfusion was diagnosed in 10 cases. There was a 27-percent chance (95% CI, 15-43%) that these febrile reactions represented bacteremia that resulted from platelet transfusion. For a subgroup of 19 patients with a temperature rise of more than 2 degrees C, the risk of bacteremia was 42 percent (95% CI, 23-64%). Septic shock occurred in 4 of the 10 bacteremic patients. A rapid diagnosis was possible because the involved bacteria were demonstrated by direct Gram stain of the samples taken from the platelet bags of all 10 patients.
Significant febrile reactions after platelet transfusion are highly likely to be indicative of bacteremia. Routine retention of platelet bags for subsequent microbiologic study was useful in the investigation of these febrile reactions. Empiric antibiotic therapy is indicated.
因血小板污染导致菌血症的风险尚不为人所知。对于血小板输注后发热反应的处理也没有既定的指南。
为了确定血小板输注后发生有症状菌血症的风险，对161例骨髓移植患者接受的3584次血小板输注进行了前瞻性研究。血小板袋在输注后常规冷藏24小时。在血小板输注后24小时内体温比输血前值升高超过2℃，或体温升高超过1℃并伴有寒战和 rigor（此处原文可能有误，推测可能是rigors，意为寒战）时，启动败血症检查。仅当从血液和血小板袋中分离出的菌株在生化特征、抗生素敏感性、血清分型或核糖体分型方面相同时，才诊断为血小板输注后菌血症。
发生了37例上述定义的发热反应。10例诊断为血小板输注后菌血症。这些发热反应有27%的可能性（95%置信区间，15 - 43%）代表由血小板输注导致的菌血症。对于19例体温升高超过2℃的患者亚组，菌血症风险为42%（95%置信区间，23 - 64%）。10例菌血症患者中有4例发生感染性休克。由于对所有10例患者的血小板袋样本进行直接革兰氏染色显示出相关细菌，所以能够快速做出诊断。
血小板输注后显著的发热反应很可能表明存在菌血症。常规保留血小板袋用于后续微生物学研究，对调查这些发热反应很有用。应进行经验性抗生素治疗。
