Because of the rising incidence of bacterial growth and septic platelet transfusions in aging units, platelet storage is currently limited in the United States to 5 days. This approved shelf life of platelets might be altered if methods were devised to rapidly detect infected units and/or to decrease the incidence of bacterially contaminated platelets. An investigation was conducted on the effect of a prototype blood collection system with an in-line filter for the production of white cell-reduced platelet-rich plasma on the growth of bacteria in platelets prepared from whole blood that had been inoculated with Staphylococcus epidermidis. Additional studies were conducted with a chemiluminescence-linked ribosomal RNA (rRNA) gene probe and with blood gas analysis to identify possible methods for the rapid detection of bacterial contamination. All units were followed for 9 days of storage. The filtration of the platelet-rich plasma resulted in an approximate 2 log10 reduction in white cells with an average loss of 6.7 percent of platelets. Filtration did not appear to alter bacterial growth. In all platelet units that supported growth, pO2 dropped to negligible values and pCO2 rose relative to culture-negative units. The changes were most sensitive and specific beyond 5 days of storage. The universal bacterial rRNA probe assay was able to detect S. epidermidis in concentrations as low as 1 x 10(3) colony-forming units per mL in some cases and reliably detected all units contaminated at a concentration of 1 x 10(4) colony-forming units per mL.(ABSTRACT TRUNCATED AT 250 WORDS)
The routine use of this assay would be expected to result in a decreased risk of septic platelet transfusion reactions and could lead to a lengthening of the current 5 day storage period for platelets. Further, the pooling of random-donor platelet concentrates before storage instead of immediately before transfusion may be possible if this rRNA probe is employed to detect bacteria in the pool.
Intravascular hemolysis due to passive transfer of anti-A or anti-B has been a frequently reported transfusion complication. In most reported cases, passive anti-A has been implicated. However, cases of hemolysis due to anti-B have also been reported following administration of intravenous immunoglobulin (IVIG) and during platelet transfusions. In our case, a 6-day-old infant with E. coli sepsis underwent double-volume exchange transfusion for hyperbilirubinemia. Modified whole blood used during the exchange consisted first of one unit of group B, D+, AS-1 packed red blood cells (RBCs), resuspended in group AB fresh frozen plasma (FFP). followed by one unit of group O, D–, CPDA-1 RJBCs resuspended in group AB FFP. During the second infusion, the infant displayed an increase in temperature and hemoglobinuria, characteristics consistent with an acute intravascular hemolytic transfusion reaction. Clerical errors and hemolysis due to polyagglutinable infant RBCs were ruled out. Further laboratory investigation revealed the presence of an anti-B antibody coating the infant’s RBCs. Follow-up testing of the O, D– donor serum revealed an anti-B titer of 16,384 (saline) and >64,000 with monospecific anti-lgG. A second uneventful double exchange was performed using washed group O, D– RBCs resuspended in 5 percent albumin.
Immunohematology
1995; 11:43–45.
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