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Published on: August 24, 2015
A suspected septic transfusion reaction associated with posttransfusion contamination of a platelet pool by
Steven J Drews1,2, Peter Lesley3, Michael E Detsky4,5
1Canadian Blood Services, Edmonton, Alberta, Canada.
Background:
Vancomycin-resistant enterococci (VRE) are antibiotic-resistant organisms associated with both colonization and serious life-threatening infection in health care settings. Contamination of platelet concentrates (PCs) with Enterococcus can result in transfusion-transmitted infection.
Case Presentation:
This report describes the investigation of a septic transfusion case involving a 27-year-old male patient with relapsed acute leukemia who was transfused with a 5-day-old buffy coat PC pool and developed fever and rigors.
Discussion:
Microbiology testing and pulse-field gel electrophoresis (PFGE) was done on patient blood cultures obtained from peripheral and central lines. Microbiology and molecular testing were also performed on the remaining posttransfusion PC pool, which was refrigerated for 24 hours before microbiology testing. Red blood cell (RBC) and plasma units associated with the implicated PCs were screened for microbial contamination. Patient blood cultures obtained from peripheral and central lines yielded vancomycin-resistant Enterococcus faecium. Gram stain of a sample from the platelet pool was negative but coagulase-negative Staphylococcus (CNST) and VRE were isolated on culture. Antibiotic sensitivity and PFGE profiles of several VRE isolates from the patient before and after transfusion, and the PC pool, revealed that all were closely related. Associated RBC and plasma components tested negative for microbial contamination.
Conclusions:
Microbiological and molecular investigations showed a relationship between VRE isolated from the patient before and after transfusion, and therefore it is postulated that a patient-to-PC retrograde contamination (from either blood or skin) occurred. As the CNST isolated from the PC pool was not isolated from patient samples, its implication in the transfusion event is unknown.
Insights
A patient developed a vancomycin-resistant Enterococcus faecium (VRE) infection after a blood transfusion. Investigations suggest retrograde contamination from the patient to the platelet concentrate pool.
Area of Science:
- Infectious Diseases
- Microbiology
- Transfusion Medicine
Background:
- Vancomycin-resistant Enterococci (VRE) pose significant risks in healthcare, causing colonization and severe infections.
- Contamination of platelet concentrates (PCs) with Enterococcus can lead to transfusion-transmitted infections.
Observation:
- A patient with relapsed acute leukemia developed fever and rigors post-transfusion with a 5-day-old buffy coat PC pool.
- Blood cultures identified VRE in the patient; VRE and coagulase-negative Staphylococcus (CNST) were isolated from the PC pool.
- Molecular typing (PFGE) confirmed a close relationship between VRE from the patient and the PC pool.
Findings:
- Microbiological and molecular investigations linked VRE in the patient to the transfused PC pool.
- A patient-to-PC retrograde contamination pathway is postulated as the source of VRE transmission.
- CNST in the PC pool was not found in the patient, its role remains unclear.
Implications:
- Highlights the risk of transfusion-transmitted VRE infections from contaminated blood products.
- Emphasizes the need for stringent screening and handling protocols for blood components.
- Underscores the importance of microbiological and molecular investigations in identifying transfusion-related sepsis.
