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Testing platelet components for bacterial contamination
William G Murphy1, Pauline Coakley
1School of Medicine and Medical Science, University College Dublin, Ireland. nmd@indigo.ie
Abstract:
Bacteria in transfused platelets can cause serious morbidity and, rarely, death. Most contaminating bacteria enter the blood at the time of venepuncture. While many of these contaminants fail to grow in the platelet unit, storage of platelets at 20-24°C facilitates growth of some organisms, and the cumulative risk of severe sepsis increases with the storage age of platelet components. Several methods have been developed or adapted to attempt to detect contaminating bacteria with high sensitivity and specificity, but the perfect test has yet to be found. Testing early in the platelet component's shelf life, even using exquisitely sensitive culture-based tests, is compromised by major problems of sample error - there may be too few bacteria present at this stage to ensure that any practical sample volume contains even one of them. Culture techniques are too slow to be useful as a release test. On the other hand, available rapid tests are too insensitive to use early in the shelf life, and have yet to show convincingly that they are sensitive enough for testing close to the time of transfusion. Nevertheless testing for bacteria in platelet components represents a significant advance in blood transfusion safety, and prevents the transfusion of many hundreds of bacterially-contaminated platelet units each year.
Insights
Bacterial contamination in transfused platelets poses serious risks. Current detection methods for bacteria in platelet components have limitations, but testing improves blood transfusion safety.
Area of Science:
- Transfusion Medicine
- Microbiology
- Blood Safety
Background:
- Bacteria contaminating platelet components can lead to severe sepsis and death.
- Contamination often occurs during venipuncture, with bacterial growth facilitated by room-temperature storage (20-24°C).
- The risk of sepsis increases with the storage duration of platelet components.
Purpose of the Study:
- To review methods for detecting bacterial contamination in platelet components.
- To assess the sensitivity and specificity of existing detection tests.
- To highlight the challenges and advancements in ensuring bacterial safety in platelet transfusions.
Main Methods:
- Review of current bacterial detection methods for platelet components.
- Analysis of limitations in sensitivity and specificity of available tests.
- Discussion of challenges related to sample error and testing timelines.
Main Results:
- No single perfect test currently exists for detecting bacterial contamination in platelet components.
- Early-life testing is hampered by low bacterial numbers and sample error.
- Rapid tests lack sufficient sensitivity for early-shelf-life or pre-transfusion testing.
Conclusions:
- Despite limitations, bacterial testing of platelet components significantly enhances blood transfusion safety.
- Current testing strategies prevent the transfusion of numerous bacterially contaminated platelet units annually.
- Further development of sensitive and rapid detection methods is needed.
