Use of hemovigilance data to evaluate the effectiveness of diversion and bacterial detection

Several preventive measures, including diversion of the first aliquot of blood and culturing of platelet (PLT) components, have been implemented to decrease the risk of transfusion-transmitted bacterial infections (TTBIs). We evaluated the effectiveness of these measures in Québec using hemovigilance data from January 2000 to December 2008.

Adverse transfusion reactions were reported to the Québec Ministry of Health by transfusion safety officers. Initial aliquot diversion, already in place for apheresis PLTs, was added to all whole blood collections in early 2003. Bacterial detection was implemented in March 2003 for apheresis PLTs and February 2005 for whole blood-derived PLTs (WBDPs).

The incidence of probable and definite TTBIs associated with WBDPs decreased from 1 in 2655 to 1 in 27,737 five-unit pools (p = 0.004) after implementation of diversion. There were no reports of TTBIs with WBDPs after culture was added to diversion, further reducing the risk to 1 in 58,123 five-unit pools (p < 0.001). There was only one TTBI associated with apheresis PLTs during the 9-year period, which occurred after implementation of both diversion and culture.

Hemovigilance data demonstrated a highly significant decrease in TTBIs associated with WBDPs, mainly attributed to the implementation of diversion. However, diversion and culture do not totally abolish the risk of TTBIs.