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Published on: January 31, 2018
Septic shock during platelet transfusion in a patient with acute myeloid leukaemia
Julie Haesebaert1, Thomas Bénet, Mauricette Michallet
1Department of Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Lyon, France.
Abstract:
Although rare, transfusion-associated bacterial contamination (TABC) is nowadays the main risk associated with platelet concentrate (PC) transfusion. Consequences vary from spontaneously resolving symptoms to severe sepsis and death. In this report we have summarised a case of bacterial contamination and sepsis during PC transfusion in a patient with acute myeloid leukaemia. Fifteen minutes after the PC transfusion began, she developed chills and rapidly worsened to septic shock. The episode was managed appropriately. The patient's blood cultures and PC unit cultures grew Escherichia coli. The microbiological susceptibilities of isolates from the patient and platelet bag were identical. No other source of E coli was found. Donor and blood products issued from the same donation investigations were negative. The causality between sepsis and PC transfusion might be difficult to confirm. As no method is available in daily practice to eliminate TABC risk, physicians should always consider TABC by immediately stopping the transfusion and conducting appropriate investigations.
Insights
Transfusion-associated bacterial contamination (TABC) is a serious risk during platelet concentrate (PC) transfusions. This case highlights Escherichia coli sepsis from a contaminated PC unit, emphasizing immediate investigation and intervention.
Area of Science:
- Hematology
- Infectious Diseases
- Transfusion Medicine
Background:
- Transfusion-associated bacterial contamination (TABC) poses the primary risk in platelet concentrate (PC) transfusions, with potential outcomes ranging from mild symptoms to fatal sepsis.
- Platelet transfusions are critical for patients with hematological conditions like acute myeloid leukemia (AML).
Observation:
- A patient with AML developed severe sepsis and septic shock rapidly after initiating a PC transfusion.
- Blood and PC unit cultures identified identical isolates of Escherichia coli, with no other source detected.
- Investigations into the donor and related blood products yielded negative results.
Findings:
- The clinical presentation and microbiological evidence strongly suggest TABC as the cause of sepsis.
- The identical E. coli strains in the patient and the PC unit confirm the link.
- Establishing definitive causality can be challenging in TABC cases.
Implications:
- Physicians must maintain a high index of suspicion for TABC in patients experiencing adverse reactions during PC transfusion.
- Immediate cessation of transfusion and prompt diagnostic workup are crucial for managing suspected TABC.
- Current practices lack methods to completely eliminate TABC risk, necessitating vigilance and preparedness.
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