Modes of bacterial contamination in stored blood
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Blood that use for transfusion faces many problems like contamination with bacteria etc
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Modes of bacterial contamination in stored blood
- 2. Modes of bacterial contaminationin stored blood: - Bacterial Contamination: Etiology Blood components may be contaminated by: 1. Unrecognized bacteremia in the donor. For example: Yersinia enterocolitica 2. Skin organisms fromthe donor. •Difficult to totally decontaminate surfaceof human skin. •Small coreof skin may enter phlebotomy needle at time of donation (~65% of donations) •Bacterial present in deep layers of skin. For example: Staphylococcusepidermidis 3. Contamination fromthe environmentor handling of the product •Leaky seals damaged tubing etc. For example: Serratia marcescens BacterialContamination— commonly implicatedbacteria: The bacterial contamination commonly implicated bacteria contains both Gram +veand Gram –vebacteria which are as follows: - Gram-negative: •Escherichia coli •Serratia marcescens •Klebsiella pneumoniae •Pseudomonasspecies •Yersinia enterocolitica
- 3. - Gram-positive: •Staphylococcusaureus •Staphylococcusepidermidis •Bacillus cereus Bacterial Contamination— Epidemiology: Epidemiology is the science that studies the patterns, causes, and effects of health and disease conditions in defined populations.
- 4. Component Bacterial Contamination Symptomatic Septic Reactions Fatal Bacterial Sepsis Platelet pool 1 in 1,000 1 in 10,000 1 in 60,000 RBC (1 unit) 1 in 50,000 1 in 250,000 1 in 500,000 1- Most frequentinfectious risk associated with transfusion. 2- Accounted for ~11% of deaths due to blood components reported to US FDA 2007-2011. 3- Occurs mostfrequently with platelets. -Stored at 20-24°C -Excellent growth medium for bacteria. Side Effects on contaminatedblood transfusion: - Immediate Adverse Effects Associated with Transfusion: •Acute hemolytic transfusion reaction •Febrile non-hemolytic transfusion reaction •Allergic reactions •Urticarial •Anaphylactic •Transfusion-associated circulatory overload (TACO) •Transfusion-associated dyspnea (TAD) •Transfusion-related acutelung injury (TRALI) •Septic transfusion reaction (bacterial contamination)
- 5. •Acute pain transfusion reaction •Hypotensivereactions •ACE Inhibitors •Non-immune red cell hemolysis •Metabolic disturbances •Hypothermia •Hyperkalemia •Acidosis Delayed Adverse Effects Associated with Transfusion: Delayed hemolytic transfusion reactions are: •Alloimmunization •Red Cell Antigens •HLA •Leukocytes •Platelets •Graft versus hostdisease(TA-GVHD) •Post-transfusion purpura (PTP) •Hemosiderosis •Viral and parasitic infections •Transfusion-related immunomodulation (TRIM) Signs and Symptoms of TR: The symptomsand signsof transfusion are: •Fever/chills/rigors •Pain •Dyspnea/respiratory distress •Bleeding •Hypotension •Hypertension •Headache •Nausea and vomiting •Rash/Hives •Angioedema •Anaphylaxis •Cyanosis •Bronchospasm •Tachycardia •Abdominal cramps •Diarrhea •Cough •Red eye •Anxiety •Jaundice
- 6. Classification of reaction by predominant symptom/sign: We will focus on 3 common symptoms and signs: 1. Fever 2. Dyspnea 3. Rash and other allergic reaction According to immunology: Immune: •Passivetransfer of donor alloantibodies in plasma of transfused product •Anti-HLA (Class I) •Anti-HLA (Class II) •Human neutrophil antigens (HNA) •Antibody binding to circulating WBC (and perhaps also pulmonary endothelium) causes cellular activation Non-immune: •TRALI is also caused by the infusion of “biologic responsemodifiers” within the blood component •Cytokines (IL-6, IL-8, IL-1, TNF- •Lipids with neutrophil-priming activity •CD40 ligand •These substances accumulate in cellular blood products with prolonged storage Silliman Serious Reaction: •Hypotension/shock •Shortness of breath •Hypoxemia •Hemoglobinuria •Nausea and vomiting •Bleeding fromIV sites •Back pain •Chest pain
- 7. Transfusion Reaction with fever: 1-Febrilenon-hemolytic transfusion reaction 2-Bacterial contamination 3-Acutehemolytic transfusion reaction 4-Usually temp greater than 39°C. Transfusion reaction with rash: •Mild allergic reactions •Serious allergic reactions •Anaphylaxis •Anaphylactoid reactions •Reactions unrelated to transfusion Transfusion reaction with dyspnea: •European Haemovigilience Network (EHN) introduced term to allow for classification of respiratory distress temporally associated with transfusion which could not be assigned to known pulmonary reactions •“Characterized by respiratory distress within 24 hours of transfusion thatdoes not meet the criteria of TRALI, TACO or allergic reaction should not be explained by patient’s underlying condition”