Yersinia enterocolitica transmission from a red cell unit 34 days old

Abstract

In 1993 the North London Blood Transfusion Centre received its first report of Yersinia enterocolitica transmission from a unit of red cells supplied to a local hospital. The recipient was a 23-year-old male who was neutropenic following a third cycle of chemotherapy for treatment of acute myeloblastic leukaemia (FAB type M6) and received a 34-day-old red cell unit. During transfusion the patient developed septicaemia and endotoxin-mediated shock. The transfusion was stopped immediately and broad spectrum antibiotics administered immediately on suspicion of bacteraemia from the transfused unit. This prompt action undoubtedly prevented a fatal outcome. Y. enterocolitica was isolated from the blood bag. Antibody was also detected in the bag and in a sample taken from the donor 39 days post-donation. Antibody to serotype 03 was identified, the commonest serotype reported in transfusion-transmitted Y. enterocolitica. The donor reported no gastrointestinal upset or illness prior to donation. This transfusion reaction might not have occurred had the red cells been transfused earlier in their storage period, but would not have been prevented by the exclusion of donors with a history of gastrointestinal illness as the donor was asymptomatic. Nor would it have been prevented by inspecting the blood for a change in colour, as no such change was observed. Y. enterocolitica is a significant problem in transfusion medicine and transmission is generally associated with a high mortality rate. Hospitals should be urged to investigate bacteriologically all appropriate transfusion reactions so that the true extent of the problem in the United Kingdom can be assessed.

Detection of Bacteria in Red Blood Cell Concentrates by the Scansystem Method

“…Although storage of RBCC at a low temperature (2 to 8°C) inhibits most bacterial growth, they are still at risk of contamination with psychrophilic bacteria such as Yersinia enterocolitica, which is now the most common cause of transfusionassociated bacterial contamination (5,11,18,22,28). The presence of these bacteria in blood products has often been associated with asymptomatic bacteremia and gastrointestinal illness of the donor (11,28).…”

“…Platelet concentrate preparations are known to carry a greater risk of bacterial infections, as they are required to be stored at 20 to 24°C (3, 6, 7, 10). With the significantly higher number of red blood cell concentrates (RBCC) transfused, however, the incidence of transfusionassociated bacterial contamination is similar (5,11,18,28). In the French Bacthem case-control study, 41 bacterium-related transfusion reactions were reported during a 2-year period, including 25 following transfusion with RBCC, with 4 fatalities, and 16 following platelet transfusion, with 2 fatalities (23).…”

Y. enterocolitica and Y. pseudotuberculosis

“…Techniques such as autologous transfusion that prevent transmission of other blood-borne infections do not prevent this syndrome (Sire et al, 1993;Haditsch et al, 1994). Donor exclusion by screening for recent gastrointestinal symptoms would exclude up to 6% of donors (Grossman et al, 1991) and would impose an unacceptable restriction on the blood supply without excluding risk from asymptomatic donors (McDonald et al, 1996). Reduction in the storage period of whole blood and red cells to less than 25 days would have implications for the blood supply (Hoppe, 1992) and would not eliminate risk.…”

Yersinia enterocolitica

“…The transmission of Yersinia through pooled platelet concentrates has been reported twice to date [16,18]. It is interesting to note that in several of the reported cases, the transfusion of platelet concentrates passed without incident while RBC concentrates from the same donation caused Yersinia sepsis resulting in death [19][20][21]. No summarised figures over a similar time period exist for Germany.…”