Platelet transfusion therapy in sub‐Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

Abstract

Background Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PT) in sub-Saharan Africa (SSA). Methods This prospective observational study evaluated the rate of BC of whole blood derived platelet units (WB-PU), the utility of performing Gram stains (GS) to prevent septic reactions, characteristics of patients receiving PT and the rate of acute reactions associated with PT at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform GS and culture using the Bactec™ 9120 instrument. Study participants were monitored for reactions. Results 337 WB-PU were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3%–2.1% (according to criteria used to define BC). The GS had high specificity (99.1%), but low sensitivity to detect units with BC. The median platelet count prior to PT was 10,900 (IQR 6,000–18,900) cells/μL. 78% of PT were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PU, for a rate of 7.3% (95%CI=3.7–12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. Conclusions The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. As GS appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially-contaminated platelets in SSA.

Bacterial surveillance of apheresis platelets in South Africa (January 2011 to December 2016)

“…Compared to what has been reported from other African countries ,the average unconfirmed South African AP contamination rate of 2·7% is comparable to the prevalence data from Uganda, below the rates published in Ghana and Zimbabwe and 10‐fold higher than the rate quoted for the high‐income countries .…”

The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

“…Testing itself also has limitations. As one example, Gram staining alone, which is used by many hospitals, has been shown to be an insensitive screening measure of bacterial contamination …”

Pathogen reduction and blood transfusion safety in Africa: strengths, limitations and challenges of implementation in low‐resource settings

“…Safeguards against bacterial contamination such as diversion pouches and blood culture, which are in routine use in high‐income countries (HICs), are not widely available and/or applied in resource‐constrained settings. Studies in Africa have shown bacterial contamination rates range from 2% to 17·5%, compared to an estimated 1 of 3000 units in the United States .…”