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Transfusion of Infected Blood

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Caution

Transfusion of blood and blood products is associated with risks and they should only be administered when the benefits are considered to outweigh these risks. Adverse transfusion reactions occur with 0.5-4% of all transfusions. If a transfusion related adverse event occurs, this should be recorded on the appropriate notification form.

In this circumstance, please contact the Transfusion Nurse Specialist or the Transfusion Medicine Specialist. We emphasise the need for Haemovigilance, which is a national programme aimed at making blood transfusion safer. See also New Zealand Blood Transfusion Medicine Handbook 2008.

Pathophysiology

Caused by infusion of blood or blood components which are bacterially contaminated due to bacteraemia in the donor, residual bacteria at the donor skin venepuncture site, or contamination in processing.

Platelets which are stored at room temperature are the blood component most likely to cause this type of reaction, with estimated risk of 1:19,519 units transfused overall. The exact incidence of this type of reaction is unknown and may be underestimated due to intercurrent illnesses within the recipient. This complication may affect autologous blood.

Clinical manifestations

  • Onset can be dramatic and quick, often within 30 minutes of starting transfusions.
  • Acute septic shock: high fevers with or without rigors, hypotension.
  • Respiratory distress.
  • Nausea, vomiting, and diarrhoea.
  • Haemoglobinuria in 20% of patients due to lysis of red cells in the blood bag.
  • Symptoms of disseminated intravascular coagulation.
  • Gram positive organisms may produce less severe effects with the onset of symptoms developing during or following the transfusion.
  • Overall, mortality for bacterially contaminated blood products, including all organisms, is approximately 25% but is higher (approx. 50%) with gram negative organisms.

Laboratory diagnosis and evaluation

Perform standard laboratory investigations including culturing of the blood bag contents and the patient's blood.

Notify blood bank: Gram stain of the blood bag contents will often reveal the presence of organisms. Organisms that have been found include:

  • Yersinia enterocolitica.
  • E.coli.
  • Serratia sp.
  • Pseudomonas sp.
  • Klebsiella sp.
  • S. aureus.
  • S. epidermidis.

Culture of blood should be performed at 4° C, 20° C, and 37° C.

Management and prevention

This is an urgent situation and after the appropriate cultures have been obtained, IV antibiotics must be given if there is a clinical reason to suspect that infected blood has been transfused.

Suitable empiric antibiotic to cover the likely bacteria is amikacin (see antibiotic protocol).

Observation of the colour of the blood units should be made before transfusing blood, as contaminated blood may be darker and have a purplish discolouration.

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Document Control

  • Date last published: 01 September 2010
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network