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Published on: August 24, 2015
Septic transfusion case caused by a platelet pool with visible clotting due to contamination with Staphylococcus
Maria Loza-Correa1, Yuntong Kou1, Mariam Taha1
1Canadian Blood Services.
Background:
Contamination of platelet concentrates (PCs) with Staphylococcus aureus is one of the most significant ongoing transfusion safety risks in developed countries.
Case Report:
This report describes a transfusion reaction in an elderly patient diagnosed with acute myeloid leukemia, transfused with a 4-day-old buffy coat PC through a central venous catheter. The transfusion was interrupted when a large fibrous clot in the PC obstructed infusion pump flow. Shortly afterward, a red blood cell (RBC) unit transfusion started. After septic symptoms were developed, the RBC transfusion was also interrupted. While the RBC unit tested negative for bacterial contamination, the PC and the patient samples were found to be contaminated with a S. aureus strain that exhibited the same phenotypic and genome sequencing profiles. The isolated S. aureus forms biofilms and produces the superantigen enterotoxin-like U, which was detected in a sample of the transfused PCs. The patient received posttransfusion antibiotic treatment and had her original central line removed and replaced.
Discussion:
As the implicated PC had been tested for bacterial contamination during routine screening yielding negative results, this is a false-negative transfusion sepsis case. Using a point-of-care test could have prevented the transfusion reaction. This report highlights the increasing incidence of S. aureus as a major PC contaminant with grave clinical implications. Importantly, S. aureus is able to interact with platelet components resulting in visible changes in PCs.
Conclusion:
Visual inspection of blood components before transfusion is an essential safety practice to interdict the transfusion of bacterially contaminated units.
Insights
Staphylococcus aureus contamination in platelet concentrates (PCs) poses a significant transfusion risk. A false-negative screening led to a severe transfusion reaction, highlighting the need for improved detection methods and visual inspection of blood products.
Area of Science:
- Transfusion Medicine
- Microbiology
- Hematology
Background:
- Platelet concentrate (PC) contamination with Staphylococcus aureus is a critical transfusion safety concern.
- Routine screening for bacterial contamination in PCs can yield false-negative results.
Observation:
- A case of transfusion reaction occurred in an elderly acute myeloid leukemia patient receiving a 4-day-old PC.
- The PC was found to be contaminated with S. aureus, which also infected the patient.
- S. aureus formed biofilms and produced enterotoxin-like U in the transfused PCs.
Findings:
- The implicated PC tested negative in routine bacterial screening.
- The patient developed septic symptoms following transfusion.
- Identical S. aureus strains were isolated from the PC and the patient, confirmed by genome sequencing.
Implications:
- Point-of-care testing could prevent such false-negative transfusion sepsis cases.
- Visual inspection of blood components is crucial for identifying contamination.
- The increasing incidence of S. aureus as a PC contaminant has serious clinical consequences.
