Consideration in Platelet Transfusion-Transmitted Klebsiella pneumoniae Sepsis: A Case Report

Transfusion-transmitted bacterial infection (TTBI) is most commonly associated with platelet transfusions. Although multiple preventive measures are routinely implemented, the risk of bacterial contamination during blood donation, processing, or storage cannot be completely eliminated. In this context, Gram-negative bacteria such as Klebsiella pneumoniae may lead to fulminant sepsis, particularly in immunocompromised patients, including those with underlying liver disease. We describe the case of a 57-year-old man classified as American Society of Anesthesiologists (ASA) III who underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure. Due to preoperative thrombocytopenia, platelet transfusion was initiated. However, approximately 15 minutes after the start of the transfusion, the patient developed tachycardia and oxygen desaturation intraoperatively, which, despite supportive measures, rapidly progressed to septic shock and multiorgan failure, ultimately resulting in death. Blood cultures grew K. pneumoniae, while bronchoalveolar lavage cultures were negative. Molecular analysis later confirmed that a second patient who received platelets from the same donor developed an infection caused by an identical bacterial strain, establishing transfusion-transmitted bacterial contamination. Although similar cases have previously been reported in the literature, this case reinforces the importance of robust hemovigilance systems, continuous improvement of transfusion safety protocols, and early recognition of septic transfusion. It also highlights the need for heightened awareness among healthcare professionals, particularly anesthesiologists, regarding signs of transfusion-associated sepsis during the perioperative period.