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Recognizing a Septic Transfusion Reaction

Case Study

Case Study:

Clinical Challenge in Recognizing a Delayed Septic Transfusion Reaction

Quality Improvement After Multiple Fatal Transfusion-Transmitted Bacterial Infections¹

Contaminated platelet bag

Contaminated platelet bag showing Staphlyococcus aureus.

A neutropenic leukemia patient received routine outpatient platelet and RBC transfusions.
Platelets and first RBC unit were transfused without incident, within minutes of starting the second RBC transfusion patient developed rigors, transfusion was stopped.
Symptoms resolved temporarily, but two hours later was admitted for neutropenic fever.
Given timeline and neutropenia, contamination of the platelet unit was not suspected, and the co-component platelet unit was not quarantined.
The following morning, visual inspection of the co-component revealed “cotton ball”-like flocculation of Staphylococcus aureus, testing revealed a match to the infection in the patient.

Case study transfusion reaction

Additional Resources

Septic transfusion poster

Download an educational poster on diagnosis of a septic transfusion reaction

Download 11"x17" Poster

1. Nelson R, Ivey J, Eder A. Transfusion 2017;57:2309-10.

INTERCEPT Blood System for Platelets and Plasma

WARNINGS AND CONTRAINDICATIONS

CONTRAINDICATIONS
Contraindicated for preparation of platelet or plasma components intended for patients with a history of hypersensitivity reaction to amotosalen or other psoralens.

Contraindicated for preparation of platelet or plasma components intended for neonatal patients treated with phototherapy devices that emit a peak energy wavelength less than 425 nm, or have a lower bound of the emission bandwidth <375 nm, due to the potential for erythema resulting from interaction between ultraviolet light and amotosalen.

WARNINGS AND PRECAUTIONS
Only INTERCEPT Processing Sets for platelets or plasma are approved for use with the INTERCEPT Blood System. Use only the INTERCEPT INT100 Illuminator for UVA illumination of amotosalen-treated platelet or plasma components. No other source of UVA light may be used. Please refer to the Operator’s Manual for the INT100 Illuminator. Discard any platelet or plasma components not exposed to the complete INT100 illumination process.

Tubing components and container ports of the INTERCEPT Blood System contain polyvinyl chloride (PVC). Di(2-ethylhexyl)phthalate (DEHP) is known to be released from PVC medical devices, and increased leaching can occur with extended storage or increased surface area contact. Blood components will be in contact with PVC for a brief period of time (approx. 15 minutes) during processing. The risks associated with DEHP released into the blood components must be weighed against the benefits of therapeutic transfusion.

PLASMA
Amotosalen-treated plasma may cause the following adverse reaction: Cardiac Events

In a randomized controlled trial of therapeutic plasma exchange (TPE) for TTP, five patients treated with INTERCEPT Blood System processed plasma and none with conventional plasma had adverse events in the cardiac system organ class (SOC) reported. These events included angina pectoris (n=3), cardiac arrest (n=1), bradycardia (n=1), tachycardia (n=1) and sinus arrhythmia (n=1). None of these events resulted in documented myocardial infarction or death. Monitor patients for signs and symptoms of cardiac events during TPE for TTP.