The impact of red blood cell manufacturing variables on bacterial growth dynamics: a pilot study

Bacterial contamination of red blood cells (RBC) remains a rare but serious clinical concern. Despite the low temperature storage of RBC, some bacteria can proliferate. The impact of RBC additive solutions (AS), manufacturing method or donor sex on bacterial growth/survival in RBC was addressed in this pilot study.

Using a partial pool-and-split design, bacterial growth/survival was assessed in intentionally inoculated RBC, manufactured separately from male and female donors using three different manufacturing methods (two whole blood [WB] filtration methods; one RBC filtration method), and resuspended in one of four AS: SAGM, PAGGSM, AS-1 or AS-3. At the beginning of storage, RBC were inoculated with 10 CFU/ml of either Klebsiella pneumoniae, Staphylococcus epidermidis, Yersinia enterocolitica or Propionibacterium acnes. Manufacturing, inoculation, storage (until day 42) and monitoring of bacterial growth were conducted at two sites: Canadian Blood Services and Héma-Québec.

Yersinia enterocolitica was the only bacterium that proliferated during storage at both sites. RBC tested at Canadian Blood Services had higher bacterial concentrations than those at Héma-Québec (P = 0·0044). At Héma-Québec, where two different manufacturing methods were used, Y. enterocolitica reached significantly higher bacterial concentrations in AS-3 RBC (WB filtration method) compared to units prepared in the other three AS (RBC filtration method; P < 0·05). Bacterial survival/growth dependent on donor sex was not uniformly noted.

Only one of four bacteria grew under RBC storage conditions. The results indicate that RBC manufacturing variables, rather than AS or donor sex, affect bacterial growth in RBC.