Shauna N. Hay

Bacterial Contamination of Blood Components

SUMMARY Blood for transfusion is a potential source of infection by a variety of known and unknown transmissible agents. Over the last 20 years, astounding reductions in the risk of viral infection via allogeneic blood have been achieved. As a result of this success, bacterial contamination of blood products has emerged as the greatest residual source of transfusion-transmitted disease. This paper summarizes the current status of detection, prevention, and elimination of bacteria in blood products for transfusion.

Validation of BacT/ALERT plastic culture bottles for use in testing of whole-blood-derived leukoreduced platelet-rich-plasma-derived platelets

BACKGROUND:  Bacterial detection of platelet (PLT)‐rich‐plasma (PRP)‐derived PLTs presents unique challenges for countries that do not allow pooling before storage. This study validated the BacT/ALERT for use in testing pooled PRP‐derived PLTs with nine contaminating organisms.

Evaluation of BacT/ALERT plastic culture bottles for use in testing pooled whole blood-derived leukoreduced platelet-rich plasma platelets with a single contaminated unit.

BACKGROUND: In certain countries, whole blood–derived platelet (PLT)‐rich plasma PLTs can only be pooled within 4 hours of transfusion. One prerequisite for prestorage pooling is the ability to detect low levels of bacteria from a single unit (approx. 10 colony‐forming units [CFUs]/mL) once pooled (10/6 approx. 2 CFUs/mL). This study evaluated the BacT/ALERT (bioMérieux) for detection of bacteria in 1 unit of a 6‐unit pool.

Monitoring of apheresis platelet bacterial contamination with an automated liquid culture system: a university experience†

BACKGROUND: With 4 million platelet units transfused per year in the United States and with the current estimate of bacteria contamination rate in PLT units, it would be expected that 2000 to 4000 bacterially contaminated units are transfused and associated with 333 to 1000 cases of clinical sepsis.

Evaluation of a new generation of plastic culture bottles with an automated microbial detection system for nine common contaminating organisms found in PLT components

BACKGROUND: A microbial detection system (BacT/ALERT 3D, bioMérieux [formerly Organon Teknika]) has previously been validated with a variety of bacterial contaminants in PLTs. The recovery of nine organisms seeded into PLTs with new plastic culture bottles was studied in comparison to the current glass bottles. The use of plastic instead of glass would be expected to reduce the risk of injury.

Cardiogenic shock complicates successful treatment of refractory thrombotic thrombocytopenia purpura with rituximab

BACKGROUND: Treatment of thrombotic thrombo‐cytopenia purpura (TTP) with daily therapeutic plasma exchange (TPE) may be accompanied by a variety of adjunctive interventions including most recently rituximab. Rituximab, a murine and human monoclonal antibody directed against CD20 antigen on B lymphocytes, is primarily used for treatment of non‐Hodgkins lymphomas. Because of severe and fatal infusion reactions including heart failure, rituximab carries a boxed warning.

Is it HIV TTP or HIV-associated thrombotic microangiopathy?

Thrombocytopenia is a common complication of Human Immunodeficiency Virus (HIV) infection. With advanced HIV disease, the presence of both thrombocytopenia and schistocytosis are frequently observed. In such cases, the diagnosis of HIV associated TTP is often considered. This article reviews emerging concepts of HIV associated microangiopathies. It concludes that the pathophysiology, in many cases seems to be distinct from idiopathic TTP (particularly with advanced HIV disease—<100 CD4/microliter). A sine que non for successful therapy of HIV‐TMA appears to be the treatment of the underlying HIV infection.infection. J. Clin. Apheresis, 2008.

Investigation of an isolate of Staphylococcus lugdunensis implicated in a platelet fatality: a possible advantage of the use of an anaerobic bottle

BACKGROUND: Cases have been reported in which detection with an early culture failed to interdict the transfusion of a bacterially contaminated platelet. One fatal case involved Staphylococcus lugdunensis, missed with a 4‐mL aerobic (BPA) bottle (BacT/ALERT, bioMérieux). This report noted “deviation from culture methods that meet manufacturers recommendations (e.g., decreased blood volume) can result in reduced sensitivity and produce false negatives.” The manufacturers package insert “strongly” recommends that more than one type of culture bottle be utilized. The utility of an anaerobic (BPN) bottle compared to a BPA bottle was investigated for the detection of S. lugdunensis.

Extended storage of AS-1 and AS-3 leukoreduced red blood cells for 15 days after deglycerolization and resuspension in AS-3 using an automated closed system.

BACKGROUND:  The utilization of cryopreserved red blood cell (RBC) units had been limited by a maximum postdeglycerolization storage of 24 hours at 1 to 6°C until the recent development of a closed system for the glycerolization and deglycerolization process.

Successful in vivo recovery and extended storage of additive solution (AS)-5 red blood cells after deglycerolization and resuspension in AS-3 for 15 days with an automated closed system

BACKGROUND: Previously, cryopreserved red blood cell (RBC) units derived from CPD/AS‐5 whole‐blood (WB) collections have been limited to 24 hours postthaw storage (1‐6°C).