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Pasteurella multocida bacteremia in asymptomatic plateletpheresis donors: a tale of two cats
Barbara J Bryant1, Cathy Conry-Cantilena, Alice Ahlgren
1Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1184, USA. bryantb2@cc.nih.gov
Background:
Bacterial contamination of platelet (PLT) concentrates occurs in 1 in 1000 to 1 in 3000 components and has been a leading cause of transfusion-associated morbidity and mortality. Two cases of Pasteurella multocida bacteremia in asymptomatic plateletpheresis donors are reported. Clinical outcomes were profoundly different, emphasizing the importance of robust methods to detect bacterial contamination.
Case Reports:
The first case occurred before the implementation of bacterial testing of PLTs. A plateletpheresis component was collected from a 70-year-old man and transfused to an 88-year-old man, who developed rigors, tachycardia, and hypotension within 15 minutes of the start of the transfusion. Cardiopulmonary arrest ensued and he expired 6 hours after transfusion. Blood cultures collected after transfusion and cultures of the PLT component were positive for the presence of P. multocida. Investigation revealed that a feral cat had bitten the donor 100 minutes before his donation. He had not reported the event to the donor room staff. The second case involved a 74-year-old woman who developed a flulike syndrome 2 days after plateletpheresis donation. P. multocida was isolated in routine bacterial culture of her PLT component. The donor had several feral cats, and although there was no history of bite or scratch, one cat liked to lick her hands, which were chapped from gardening.
Conclusion:
Occult bacteremia with P. multocida transmitted by feral cats was the source of PLT contamination in two cases over 3 years. Bacterial testing of PLTs is critical in the prevention of transfusion-acquired sepsis and allows the identification and treatment of asymptomatic bacteremic donors.
Insights
Feral cat contact led to Pasteurella multocida contamination in platelet concentrates, causing severe transfusion reactions. Bacterial testing of platelets is crucial for preventing sepsis and identifying bacteremic donors.
Area of Science:
- Transfusion Medicine
- Infectious Disease
- Microbiology
Background:
- Bacterial contamination of platelet (PLT) concentrates is a significant risk, causing transfusion-associated morbidity and mortality.
- Prevalence ranges from 1 in 1000 to 1 in 3000 PLT components.
- Pasteurella multocida bacteremia in asymptomatic platelet donors presents a unique challenge.
Observation:
- Two cases of Pasteurella multocida bacteremia in platelet donors are presented.
- Case 1: A donor bitten by a feral cat transmitted P. multocida, leading to a fatal transfusion reaction in the recipient.
- Case 2: A donor with cat contact, without a reported bite, had P. multocida in her PLT component, resulting in a mild, flu-like illness in the donor.
Findings:
- Occult bacteremia with P. multocida, transmitted via feral cat contact, was identified as the source of PLT contamination in both cases.
- The clinical outcomes varied significantly, highlighting the unpredictable nature of transfusion-transmitted infections.
- Donor 1 had a reported cat bite prior to donation; Donor 2 had indirect contact with feral cats.
Implications:
- Bacterial testing of platelet products is critical for preventing transfusion-acquired sepsis.
- Early detection of bacteremic donors is essential for patient safety.
- Understanding potential transmission routes, such as animal contact, can improve donor screening and blood safety protocols.
