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Alipourfard I, Darvishi M, Khalighfard A, Ghazi F, Mobed A. Nanomaterial-based methods for sepsis management. Enzyme Microb Technol 2024; 174:110380. [PMID: 38147783 DOI: 10.1016/j.enzmictec.2023.110380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
Sepsis is a serious disease caused by an impaired host immune response to infection, resulting in organ dysfunction, tissue damage and is responsible for high in-hospital mortality (approximately 20%). Recently, WHO documented sepsis as a global health priority. Nevertheless, there is still no effective and specific therapy for clinically detecting sepsis. Nanomaterial-based approaches have appeared as promising tools for identifying bacterial infections. In this review, recent biosensors are introduced and summarized as nanomaterial-based platforms for sepsis management and severe complications. Biosensors can be used as tools for the diagnosis and treatment of sepsis and as nanocarriers for drug delivery. In general, diagnostic methods for sepsis-associated bacteria, biosensors developed for this purpose are presented in detail, and their strengths and weaknesses are discussed. In other words, readers of this article will gain a comprehensive understanding of biosensors and their applications in sepsis management.
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Affiliation(s)
- Iraj Alipourfard
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Sciences, University of Silesia, Katowice, Poland
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Arghavan Khalighfard
- Department of Nursing and Midwifery٫ Faculty of Midwifery٬ Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farhood Ghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz 5154853431, Iran
| | - Ahmad Mobed
- Infectious and Tropical Diseases Research Center, Clinical Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Jacobs MR, Zhou B, Tayal A, Maitta RW. Bacterial Contamination of Platelet Products. Microorganisms 2024; 12:258. [PMID: 38399662 PMCID: PMC10891786 DOI: 10.3390/microorganisms12020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Transfusion of bacterially contaminated platelets, although rare, is still a major cause of mortality and morbidity despite the introduction of many methods to limit this over the past 20 years. The methods used include improved donor skin disinfection, diversion of the first part of donations, use of apheresis platelet units rather than whole-blood derived pools, primary and secondary testing by culture or rapid test, and use of pathogen reduction. Primary culture has been in use the US since 2004, using culture 24 h after collection of volumes of 4-8 mL from apheresis collections and whole-blood derived pools inoculated into aerobic culture bottles, with limited use of secondary testing by culture or rapid test to extend shelf-life from 5 to 7 days. Primary culture was introduced in the UK in 2011 using a "large-volume, delayed sampling" (LVDS) protocol requiring culture 36-48 h after collection of volumes of 16 mL from split apheresis units and whole-blood derived pools, inoculated into aerobic and anaerobic culture bottles (8 mL each), with a shelf-life of 7 days. Pathogen reduction using amotosalen has been in use in Europe since 2002, and was approved for use in the US in 2014. In the US, recent FDA guidance, effective October 2021, recommended several strategies to limit bacterial contamination of platelet products, including pathogen reduction, variants of the UK LVDS method and several two-step strategies, with shelf-life ranging from 3 to 7 days. The issues associated with bacterial contamination and these strategies are discussed in this review.
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Affiliation(s)
- Michael R. Jacobs
- Department of Pathology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (B.Z.); (A.T.); (R.W.M.)
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Villa CH, Illoh O, Kracalik I, Basavaraju SV, Eder AF. Posttransfusion sepsis attributable to bacterial contamination in platelet collection set manufacturing, United States. Transfusion 2023; 63:2351-2357. [PMID: 37909342 DOI: 10.1111/trf.17589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Affiliation(s)
- C H Villa
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - O Illoh
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - I Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A F Eder
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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O’Flaherty N, Bryce L, Nolan J, Lambert M. Changing Strategies for the Detection of Bacteria in Platelet Components in Ireland: From Primary and Secondary Culture (2010-2020) to Large Volume Delayed Sampling (2020-2023). Microorganisms 2023; 11:2765. [PMID: 38004776 PMCID: PMC10673373 DOI: 10.3390/microorganisms11112765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Bacterial contamination of platelet components (PC) poses the greatest microbial risk to recipients, as bacteria can multiply over the course of PC storage at room temperature. Between 2010 and 2020, the Irish Blood Transfusion Service (IBTS) screened over 170,000 buffy coat-derived pooled (BCDP) and single-donor apheresis platelets (SDAPs) with the BACT/ALERT 3D microbial detection system (Biomerieux, L'Etoile, France), using a two-step screening protocol which incorporated primary and secondary cultures. Although the protocol was successful in averting septic transfusion reactions (STRs), testing large sample volumes at later time points was reported to improve detection of bacterial contamination. A modified large-volume delayed sampling (LVDS)-type protocol was adopted in 2020, which in the case of SDAP was applied to collections rather than individual splits (2020-2023, 44,642 PC screened). Rates of bacterial contamination for BCDP were 0.125% on Day-2, 0.043% on Day-4 vs. 0.191% in the post-LVDS period. SDAP contamination rates in the pre-LVDS period were 0.065% on Day-1, 0.017% on Day-4 vs. 0.072% in the post-LVDS period. Confirmed STRs were absent, and the interdiction rate for possibly contaminated SDAP was over 70%. In the post-LVDS period, BCDPs had a higher total positivity rate than SDAPs, 0.191% (1:525) versus 0.072% (1:1385), respectively, (chi-squared 12.124, 1 df, p = 0.0005). The majority of organisms detected were skin-flora-type, low pathogenicity organisms, including coagulase-negative staphylococci and Cutibacterium acnes, with little change in the frequency of clinically significant organisms identified over time. Both protocols prevented the issue of potentially harmful components contaminated (rarely) with a range of pathogenic bacteria, including Escherichia coli, Serratia marcesens, Staphylococcus aureus, and streptococci. Culture positivity of outdates post-LVDS whereby 100% of expired platelets are retested provides a residual risk estimate of 0.06% (95% CI 0.016-0.150). However, bacterial contamination rates in expired platelets did not demonstrate a statistically significant difference between the pre-LVDS 0.100% (CI 0.033-0.234) and post-LVDS 0.059% (0.016-0.150) periods (chi-squared = 0.651, 1 df, p = 0.42).
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Affiliation(s)
- Niamh O’Flaherty
- Irish Blood Transfusion Service, National Blood Centre, D08 NH5R Dublin, Ireland; (L.B.); (M.L.)
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5
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Kracalik I, Kent AG, Villa CH, Gable P, Annambhotla P, McAllister G, Yokoe D, Langelier CR, Oakeson K, Noble-Wang J, Illoh O, Halpin AL, Eder AF, Basavaraju SV. Posttransfusion Sepsis Attributable to Bacterial Contamination in Platelet Collection Set Manufacturing Facility, United States. Emerg Infect Dis 2023; 29:1979-1989. [PMID: 37561399 PMCID: PMC10521617 DOI: 10.3201/eid2910.230869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
During May 2018‒December 2022, we reviewed transfusion-transmitted sepsis cases in the United States attributable to polymicrobial contaminated apheresis platelet components, including Acinetobacter calcoaceticus‒baumannii complex or Staphylococcus saprophyticus isolated from patients and components. Transfused platelet components underwent bacterial risk control strategies (primary culture, pathogen reduction or primary culture, and secondary rapid test) before transfusion. Environmental samples were collected from a platelet collection set manufacturing facility. Seven sepsis cases from 6 platelet donations from 6 different donors were identified in patients from 6 states; 3 patients died. Cultures identified Acinetobacter calcoaceticus‒baumannii complex in 6 patients and 6 transfused platelets, S. saprophyticus in 4 patients and 4 transfused platelets. Whole-genome sequencing showed environmental isolates from the manufacturer were closely related genetically to patient and platelet isolates, indicating the manufacturer was the most probable source of recurrent polymicrobial contamination. Clinicians should maintain awareness of possible transfusion-transmitted sepsis even when using bacterial risk control strategies.
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6
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Ramirez-Arcos S, Garcia-Otalora M, McDonald C. Microbiological environmental contamination in the blood supply chain: An international survey by the bacterial subgroup of the ISBT Transfusion-Transmitted Infectious Diseases Working Party. Vox Sang 2023; 118:656-665. [PMID: 37272122 DOI: 10.1111/vox.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood transfusion centres ensure the quality and safety of transfusable blood components. However, septic transfusion reactions involving environmental contaminants occur. An international survey issued by the ISBT Transfusion-Transmitted Infectious Diseases Working Party (ISBT-TTID-WP) Bacterial Subgroup aimed to collect information regarding microbiological environmental monitoring from transfusion services. MATERIALS AND METHODS A Form survey (English and Spanish) with 35 questions was sent to ISBT-TTID-WP members. The survey had four sections: (1) respondent personal information, (2) cleaning/disinfection practices during blood component manufacturing, (3) cleaning/disinfection practices during blood component storage and (4) blood component storage bag integrity. Respondents completed the survey electronically, and data were comparatively analysed using Microsoft Excel. RESULTS There were 49 responses from 20 countries. Five of 49 sites manufacture blood components in a cleanroom, and most use personal protective equipment, although the type varied between sites. Approximately 40% of sites perform environmental monitoring during blood component production, with seven sites providing details about frequency and methods. Most (~94%) centres have procedures for cleaning/disinfection of processing and storage facilities with varying responses regarding areas, frequency and methods. Inconsistency was reported regarding the orientation of platelet component incubation (portrait vs. landscape). Over 93% of sites assess storage bag integrity and report damage to manufacturers, and 49% of centres report septic transfusion reactions potentially linked to damaged storage containers. CONCLUSION Data from this survey highlight the need for consensual guidelines for transfusion services regarding cleaning and disinfection practices. Environmental monitoring could be adopted to minimize the risk of blood component contamination for transfusion patient safety.
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Affiliation(s)
- Sandra Ramirez-Arcos
- Innovation & Portfolio Management, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Garcia-Otalora
- School of Medicine and Health Science, Public Health Research Group, Universidad del Rosario, Bogotá, Colombia
- Coordinacion Red Nacional de Bancos de Sangre y Servicios de Transfusion, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carl McDonald
- Retired, National Health Service Blood and Transplant, London, UK
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Green AB, Chiaraviglio L, Truelson KA, Zulauf KE, Cui M, Zhang Z, Ware MP, Flegel WA, Haspel RL, Yu EW, Kirby JE. RND Pump-Mediated Efflux of Amotosalen, a Compound Used in Pathogen Inactivation Technology to Enhance Safety of Blood Transfusion Products, May Compromise Its Gram-Negative Anti-Bacterial Activity. mSphere 2023;:e0067322. [PMID: 36853056 DOI: 10.1128/msphere.00673-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Pathogen inactivation is a strategy to improve the safety of transfusion products. The only pathogen reduction technology for blood products currently approved in the US utilizes a psoralen compound, called amotosalen, in combination with UVA light to inactivate bacteria, viruses, and protozoa. Psoralens have structural similarity to bacterial multidrug efflux pump substrates. As these efflux pumps are often overexpressed in multidrug-resistant pathogens, we tested whether contemporary drug-resistant pathogens might show resistance to amotosalen and other psoralens based on multidrug efflux mechanisms through genetic, biophysical, and molecular modeling analysis. The main efflux systems in Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa are tripartite resistance-nodulation-cell division (RND) systems, which span the inner and outer membranes of Gram-negative pathogens, and expel antibiotics from the bacterial cytoplasm into the extracellular space. We provide evidence that amotosalen is an efflux substrate for the E. coli AcrAB, Acinetobacter baumannii AdeABC, and P. aeruginosa MexXY RND efflux pumps. Furthermore, we show that the MICs for contemporary Gram-negative bacterial isolates for these species and others in vitro approached and exceeded the concentration of amotosalen used in the approved platelet and plasma inactivation procedures. These findings suggest that otherwise safe and effective inactivation methods should be further studied to identify possible gaps in their ability to inactivate contemporary, multidrug-resistant bacterial pathogens. IMPORTANCE Pathogen inactivation is a strategy to enhance the safety of transfused blood products. We identify the compound, amotosalen, widely used for pathogen inactivation, as a bacterial multidrug efflux substrate. Specifically, experiments suggest that amotosalen is pumped out of bacteria by major efflux pumps in E. coli, Acinetobacter baumannii, and Pseudomonas aeruginosa. Such efflux pumps are often overexpressed in multidrug-resistant pathogens. Importantly, the MICs for contemporary multidrug-resistant Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Burkholderia spp., and Stenotrophomonas maltophilia isolates approached or exceeded the amotosalen concentration used in approved platelet and plasma inactivation procedures, potentially as a result of efflux pump activity. Although there are important differences in methodology between our experiments and blood product pathogen inactivation, these findings suggest that otherwise safe and effective inactivation methods should be further studied to identify possible gaps in their ability to inactivate contemporary, multidrug-resistant bacterial pathogens.
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Pitman JP, Payrat JM, Park MS, Liu K, Corash L, Benjamin RJ. Longitudinal analysis of annual national hemovigilance data to assess pathogen reduced platelet transfusion trends during conversion to routine universal clinical use and 7-day storage. Transfusion 2023; 63:711-723. [PMID: 36802055 DOI: 10.1111/trf.17285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND France converted to universal pathogen reduced (PR; amotosalen/UVA) platelets in 2017 and extended platelet component (PC) shelf-life from 5- to 7-days in 2018 and 2019. Annual national hemovigilance (HV) reports characterized longitudinal PC utilization and safety over 11 years, including several years prior to PR adoption as the national standard of care. METHODS Data were extracted from published annual HV reports. Apheresis and pooled buffy coat [BC] PC use was compared. Transfusion reactions (TRs) were stratified by type, severity, and causality. Trends were assessed for three periods: Baseline (2010-14; ~7% PR), Period 1 ([P1] 2015-17; 8%-21% PR), and Period 2 ([P2] 2018-20; 100% PR). RESULTS PC use increased by 19.1% between 2010 and 2020. Pooled BC PC production increased from 38.8% to 68.2% of total PCs. Annual changes in PCs issued averaged 2.4% per year at baseline, -0.02% (P1) and 2.8% (P2). The increase in P2 coincided with a reduction in the target platelet dose and extension to 7-day storage. Allergic reactions, alloimmunization, febrile non-hemolytic TRs, immunologic incompatibility, and ineffective transfusions accounted for >90% of TRs. Overall, TR incidence per 100,000 PCs issued declined from 527.9 (2010) to 345.7 (2020). Severe TR rates declined 34.8% between P1-P2. Forty-six transfusion-transmitted bacterial infections (TTBI) were associated with conventional PCs during baseline and P1. No TTBI were associated with amotosalen/UVA PCs. Infections with Hepatitis E (HEV) a non-enveloped virus resistant to PR, were reported in all periods. DISCUSSION Longitudinal HV analysis demonstrated stable PC utilization trends with reduced patient risk during conversion to universal 7-day amotosalen/UVA PCs.
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Affiliation(s)
- John P Pitman
- Scientific and Medical Affairs, Cerus Corporation, Concord, California, USA
| | | | - Min-Sun Park
- Biostatistics and Data Management, Cerus Corporation, Concord, California, USA
| | - Kathy Liu
- Biostatistics and Data Management, Cerus Corporation, Concord, California, USA
| | - Laurence Corash
- Scientific and Medical Affairs, Cerus Corporation, Concord, California, USA
| | - Richard J Benjamin
- Scientific and Medical Affairs, Cerus Corporation, Concord, California, USA
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Szczepiorkowski ZM, Pagano MB. Platelet components and bacterial contamination: hospital perspective 2022. Hematology Am Soc Hematol Educ Program 2022; 2022:430-6. [PMID: 36485080 DOI: 10.1182/hematology.2022000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bacterial contamination of platelet units has been one of the most common transfusion-transmitted infections. Approximately 4 to 7 fatalities are being reported to the US Food and Drug Administration (FDA) annually, which cites bacterially contaminated platelet units as the cause. Over the past 3 decades, different mitigation strategies have been introduced to minimize the risk of morbidity and mortality related to contaminated platelet units. The process of platelet collection and manufacturing as well as storage at 20°C to 24°C contributes to higher prevalence of contaminated units. The risk of transfusing bacterially contaminated platelets can be lowered using different types of interventions. Prevention of bacterial contamination can be done by strict adherence to techniques that minimize contamination during unit collection. The detection of bacteria in platelet products can be improved with a combination of rapid testing and bacterial cultures that involve large volume and delayed sampling. Finally, pathogen reduction can inactivate bacteria or other pathogens present in the unit. This article describes different strategies that blood centers and transfusion services have undertaken since October 2021 to meet FDA guidance requirements. Market forces as well as feasibility of different FDA-proposed approaches have limited the number of practical solutions to just a few. In addition, the blood product availability required hospitals to adopt more progressive strategies to provide patients with needed platelet products.
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10
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Kerantzas CA, Merwede J, Snyder EL, Hendrickson JE, Tormey CA, Kazmierczak BI, Peaper DR. Assessment of polymicrobial interactions in bacterial isolates from transfused platelet units associated with sepsis. Transfusion 2022; 62:2458-2463. [PMID: 36178430 DOI: 10.1111/trf.17136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 07/31/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In 2019 the Centers for Disease Control and Prevention (CDC) reported a series of 4 transfusion reactions that resulted from contamination of apheresis platelet products. Products involved in all 4 cases were contaminated with Acinetobacter calcoaceticus-baumannii complex (ACBC) and in 3 products Staphylococcus saprophyticus was found as well. CDC investigation found that bacterial isolates from the cases were genetically related and suggested a common source of contamination. The contamination of blood products with ACBC is rare and polymicrobial contamination of blood products even less common. ACBC and S. saprophyticus have been observed to adhere to one another and sediment out of suspension in vitro, a process referred to as coaggregation, and we hypothesized that there was an interaction between the strains from these cases that contributed to their co-contamination of blood products. STUDY DESIGN AND METHODS To test the hypothesis of bacterial interaction, we performed coaggregation experiments and observed the growth characteristics of ACBC and S. saprophyticus strains recovered from contaminated blood products involved in a subset of the CDC cases. RESULTS An increase in S. saprophyticus CFU concentration was observed after several days of co-culture with ACBC in LB and plasma; however, no other findings suggested coaggregation or augmentative growth interaction between the bacterial strains. CONCLUSION Ultimately, an interaction between ACBC and S. saprophyticus that could help explain their co-occurrence and growth in contaminated platelet units was not found; however future studies of potential interactions may be warranted.
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Affiliation(s)
| | - Jacob Merwede
- Department of Laboratory Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Edward L Snyder
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut, USA
| | | | | | - Barbara I Kazmierczak
- Department of Internal Medicine, Section of Infectious Disease, Yale University, New Haven, Connecticut, USA.,Department of Microbial Pathogenesis, Yale University, New Haven, Connecticut, USA
| | - David R Peaper
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut, USA
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11
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Wagner SJ, Snyder EL. Identification and management of bacterially contaminated platelets-Back to the future. Transfusion 2022; 62:1948-1960. [PMID: 36059246 DOI: 10.1111/trf.17088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Edward L Snyder
- Transfusion Medicine Service, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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12
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Schmidt M, Ramirez-Arcos S, Stiller L, McDonald C. Current status of rapid bacterial detection methods for platelet components: A 20-year review by the ISBT Transfusion-Transmitted Infectious Diseases Working Party Subgroup on Bacteria. Vox Sang 2022; 117:983-988. [PMID: 35412655 DOI: 10.1111/vox.13283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Bacterial contamination of platelet components (PCs) poses a safety challenge for transfusion patients. Despite mitigation interventions, the residual risk of transfusion-transmitted bacterial infections remains predominant. PC safety can be improved either by pathogen reduction or by implementation of bacterial detection methods. Detection methodologies include culture methods and rapid detection methods. The current review focuses on currently available rapid detection methods. MATERIALS AND METHODS We reviewed published manuscripts since 2000 on rapid bacterial detection methods used for PC screening with result determination within 4 h. Methods meeting this criterion included Verax PGDprime, BacTx and nucleic amplification testing. The analytical and diagnostic sensitivity and specificity of these systems were assessed. RESULTS The analytical sensitivity between the different detection methods ranged between 50 and 100,000 CFU/ml. The sample volume used by these testing systems varies between 0.5 and 1.0 ml of PCs. A delay of at least 48 h before sampling enhances detectability. All rapid detection methods generate results in a timely manner, allowing testing to be performed before transfusion with optimal sensitivity. CONCLUSION Rapid detection methods improve PC safety regarding bacterial contamination. The assays are optimal for rapidly growing bacteria, which are more likely to cause septic transfusion reactions in patients. Because of the reduced diagnostic sensitivity, the sample collection should be late in shelf-life and ideally just before transfusion. The major benefit of these methods is that the test result can be obtained before releasing PCs for transfusion or to be used in combination with other screening methods applied early during PC storage.
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Affiliation(s)
| | - Sandra Ramirez-Arcos
- Department of Microbiology, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Microbiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Lea Stiller
- German Red Cross, Institute Frankfurt, Frankfurt, Germany
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13
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Ruby KN, Khan J, Martin IW, Dunbar NM. Application of Standardized Residual Component Culture Criteria for Suspected Septic Transfusion Reactions Would Increase the Component Culturing Rate at a Single Academic Medical Center. Am J Clin Pathol 2022; 158:216-220. [PMID: 35311936 DOI: 10.1093/ajcp/aqac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The 2019 SCARED study developed the Biomedical Excellence for Safer Transfusion (BEST) criteria in an effort to standardize the decision to culture residual units in the context of suspected septic transfusion reactions (STRs). The goal of this study was to apply the BEST criteria to determine the effect on the transfusion reaction decision to culture. METHODS This retrospective, single-center, cross-sectional study assessed adult transfusion reactions identified in calendar years 2013 to 2020. Reactions following transfusion of RBCs, platelets, and plasma were included, and the decisions to culture following strict application of BEST criteria were compared with decisions to culture in actual practice. RESULTS In total, 1,068 transfusion reactions were reported and 200 (19%) suspected STRs were cultured, all with negative results; 303 (28%) reactions would have been cultured per strict application of the BEST criteria. Concordance between actual culture decision and BEST criteria recommendation was 62% for cultured components and 79% for components that were not cultured. CONCLUSIONS BEST criteria provide objective recommendations of when to culture residual units implicated in suspected STRs, but strict application of these criteria may result in increased culture rates. Clinical correlation to aid in the decision to culture is recommended.
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Affiliation(s)
- Kristen N Ruby
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Isabella W Martin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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14
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Cloutier M, De Korte D. Residual risks of bacterial contamination for
pathogen‐reduced
platelet components. Vox Sang 2022; 117:879-886. [DOI: 10.1111/vox.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/22/2021] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Cloutier
- Medical Affairs and Innovation Héma‐Québec Québec Canada
- Biochemistry, Microbiology and Bio‐informatics Université Laval Québec Canada
| | - Dirk De Korte
- Blood Cell Research Sanquin Research Amsterdam The Netherlands
- Product and Process Development Sanquin Blood Bank Amsterdam The Netherlands
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15
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Ohanian M, Cancelas JA, Davenport R, Pullarkat V, Hervig T, Broome C, Marek K, Kelly M, Gul Z, Rugg N, Nestheide S, Kinne B, Szczepiorkowski Z, Kantarjian H, Pehta J, Biehl R, Yu A, Aung F, Antebi B, Fitzpatrick GM. Freeze-dried platelets are a promising alternative in bleeding thrombocytopenic patients with hematological malignancies. Am J Hematol 2022; 97:256-266. [PMID: 34748664 DOI: 10.1002/ajh.26403] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
Thrombosomes are trehalose-stabilized, freeze-dried group O platelets with a 3-year shelf life. They can be stockpiled, rapidly reconstituted, and infused regardless of the recipient's blood type. Thrombosomes thus represent a potential alternative platelet transfusion strategy. The present study assessed the safety and potential early signals of efficacy of Thrombosomes in bleeding thrombocytopenic patients. We performed an open-label, phase 1 study of single doses of allogeneic Thrombosomes at three dose levels in three cohorts, each consisting of eight patients who had hematologic malignancies, thrombocytopenia, and bleeding. Adverse events, dose-limiting toxicities (DLTs), World Health Organization (WHO) bleeding scores, and hematology values were assessed. No DLTs were reported. The median age was 59 years (24-71). Most patients had AML (58%) or ALL (29%), followed by MDS (8%) and myeloproliferative neoplasm (4%). The WHO scores of 22 patients who were actively bleeding at a total of 27 sites at baseline either improved (n = 17 [63%]) or stabilized (n = 10 [37%]) through day 6. Twenty-four hours after infusion, 12 patients (50%) had a clinically significant platelet count increase. Of eight patients who received no platelet transfusions for 6 days after Thrombosomes infusion, 5 had a clinically significant increase in platelet count of ≥5000 platelets/μL and 2 had platelet count normalization. Thrombosomes doses up to 3.78 × 108 particles/kg demonstrated safety in 24 bleeding, thrombocytopenic patients with hematological malignancies. Thrombosomes may represent an alternative to conventional platelets to treat bleeding. A phase 2 clinical trial in a similar patient population is underway.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | | | - Vinod Pullarkat
- City of Hope Comprehensive Cancer Center Duarte California USA
| | - Tor Hervig
- Haukeland Universitetssjukehus Bergen Norway
| | - Catherine Broome
- MedStar Georgetown University Hospital Washington District of Columbia USA
| | - Kelly Marek
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mary Kelly
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zartash Gul
- Division of Hematology/Oncology, Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Neeta Rugg
- Hoxworth Blood Center Cincinnati Ohio USA
| | | | - Bridget Kinne
- Division of Hematology/Oncology, Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA
| | | | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Joan Pehta
- The Alpha Bio Group New Canaan Connecticut USA
| | - Ruth Biehl
- Cellphire Therapeutics Rockville Maryland USA
| | - Anna Yu
- Cellphire Therapeutics Rockville Maryland USA
| | - Fleur Aung
- Department of Transfusion Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ben Antebi
- Cellphire Therapeutics Rockville Maryland USA
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16
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Kamel H, Ramirez-Arcos S, McDonald C. The international experience of bacterial screen testing of platelet components with automated microbial detection systems: An update. Vox Sang 2022; 117:647-655. [PMID: 35178718 DOI: 10.1111/vox.13247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 12/22/2022]
Abstract
In 2014, the bacterial subgroup of the Transfusion-Transmitted Infectious Diseases working party of ISBT published a review on the International Experience of Bacterial Screen Testing of Platelet Components (PCs) with an Automated Microbial Detection System. The purpose of this review, which is focused on publications on or after 2014, is to summarize recent experiences related to bacterial contamination of PCs and the use of an automated culture method to safeguard the blood supply. We first reviewed septic transfusion reactions after PC transfusion as reported in national haemovigilance systems along with a few reports from various countries on bacterial contamination of blood products. Next, we reviewed PC automated culture protocols employed by national blood services in the United Kingdom, Australia, Canada and large blood collection organization and hospital transfusion services in the United States. Then, we acknowledged the limitations of currently available culture methodologies in abating the risks of transfusion-transmitted bacterial infection, through a review of case reports. This review was neither meant to be critical of the literature reviewed nor meant to identify or recommend a best practice. We concluded that significant risk reduction can be achieved by one or a combination of more than one strategy. No one approach is feasible for all institutions worldwide. In selecting strategies, institutions should consider the possible impact on platelet components availability and entertain a risk-based decision-making approach that accounts for operational, logistical and financial factors.
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Affiliation(s)
- Hany Kamel
- Medical Affairs, Vitalant, Scottsdale, Arizona, USA
| | - Sandra Ramirez-Arcos
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada.,University of Ottawa, Ottawa, Canada
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17
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Prioli KM, Abersone I, Kopko PM, Herman JH, Custer B, Pizzi LT. Economic implications of FDA platelet bacterial guidance compliance options: Comparison of single-step strategies. Transfusion 2022; 62:365-373. [PMID: 34997763 PMCID: PMC9303536 DOI: 10.1111/trf.16778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bloodborne pathogens pose a major safety risk in transfusion medicine. To mitigate the risk of bacterial contamination in platelet units, FDA issues updated guidance materials on various bacterial risk control strategies (BRCS). This analysis presents results of a budget impact model updated to include 5- and 7-day pathogen reduced (PR) and large volumed delayed sampling (LVDS) BRCS. STUDY DESIGN AND METHODS Model base-case parameter inputs were based on scientific literature, a survey distributed to 27 US hospitals, and transfusion experts' opinion. The outputs include hospital budget and shelf-life impacts for 5- and 7-day LVDS, and 5- and 7-day PR units under three different scenarios: (1) 100% LVDS, (2) 100% PR, and (3) mix of 50% LVDS - and 50% PR. RESULTS Total annual costs from the hospital perspective were highest for 100% LVDS platelets (US$2.325M) and lowest for 100% PR-7 units (US$2.170M). Net budget impact after offsetting annual costs by outpatient reimbursements was 5.5% lower for 5-day PR platelets as compared to 5-day LVDS (US$1.663 vs. US$1.760M). A mix of 7-day LVDS and 5-day PR platelets had net annual costs that were 1.3% lower than for 100% 7-day LVDS, but 1.3% higher than for 100% 5-day PR. 7-day PR platelets had the longest shelf life (4.63 days), while 5-day LVDS had the shortest (2.00 days). DISCUSSION The model identifies opportunities to minimize transfusion center costs for 5- and 7-day platelets. Budget impact models such as this are important for understanding the financial implications of evolving FDA guidance and new platelet technologies.
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Affiliation(s)
- Katherine M Prioli
- Center for Health Outcomes, Policy and Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Ilze Abersone
- Center for Health Outcomes, Policy and Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Patricia M Kopko
- Division of Transfusion Medicine, University of California San Diego, San Diego, California, USA
| | - Jay H Herman
- Division of Transfusion Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy and Economics, Rutgers University, Piscataway, New Jersey, USA
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18
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Gammon RR, Reik RA, Stern M, Vassallo RR, Waxman DA, Young PP, Benjamin RJ. Acquired platelet storage container leaks and contamination with environmental bacteria: A preventable cause of bacterial sepsis. Transfusion 2021; 62:641-650. [PMID: 34927291 PMCID: PMC9299677 DOI: 10.1111/trf.16776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
Background Apheresis platelets (AP) may be contaminated by environmental bacteria via container defects acquired during processing, transport, storage, or transfusion, as highlighted by a recent series of septic reactions related to Acinetobacter spp. and other bacterial strains. Study design and methods The frequency and nature of acquired container defect reports to one manufacturer were evaluated from January 2019 to July 2020. The published incidence of contamination and sepsis due to environmental bacteria with culture screened AP in the United States was reviewed for the period of 2010–2019. Results Review of a manufacturers' records showed 23 US reports of leaks involving 24 containers attributed to postmanufacturing damage, at a rate of 44 per million distributed storage containers. Analysis of returned containers showed evidence of scratches, impressions, and/or piercings. Literature review of US hemovigilance data revealed that environmental bacteria comprised 7% of confirmed positive primary bacterial culture screens, were responsible for 14%–16% of reported septic, and 8 of 28 (29%) fatal reactions with bacterial‐culture screened AP. Sepsis cases have been reported with culture screened, point‐of‐issue (POI) tested, or pathogen‐reduced AP. Discussion Environmental contamination of AP is rare but can cause sepsis. Container damage provides a pathway for contamination after culture screening, POI bacteria testing, or pathogen reduction. Blood collectors and transfusion services should have procedures to ensure proper inspection, handling, storage, and transport of AP to avoid damage and should enhance efforts to detect defects prior to release and to eliminate bacteria from all contacting surfaces to minimize the risk of contamination.
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Affiliation(s)
- Richard R Gammon
- Scientific, Medical, Technical Division, OneBlood, Orlando, Florida, USA
| | - Rita A Reik
- Scientific, Medical, Technical Division, OneBlood, Orlando, Florida, USA
| | - Marc Stern
- Product Management, Cerus Corporation, Concord, California, USA
| | | | - Dan A Waxman
- Transfusion Medicine Blood Services, Versiti, Indianapolis, Indiana, USA
| | - Pampee P Young
- Biomedical Services, American Red Cross, Washington, DC, USA
| | - Richard J Benjamin
- Clinical Research and Medical Affairs, Cerus Corporation, Concord, California, USA
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19
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Savinkina AA, Haass KA, Sapiano MRP, Henry RA, Berger JJ, Basavaraju SV, Jones JM. Transfusion-associated adverse events and implementation of blood safety measures - findings from the 2017 National Blood Collection and Utilization Survey. Transfusion 2021; 60 Suppl 2:S10-S16. [PMID: 32134123 DOI: 10.1111/trf.15654] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serious transfusion-associated adverse events are rare in the United States. To enhance blood safety, various measures have been developed. With use of data from the 2017 National Blood Collection and Utilization Survey (NBCUS), we describe the rate of transfusion-associated adverse events and the implementation of specific blood safety measures. STUDY DESIGN AND METHODS Data from the 2017 NBCUS were used with comparison to already published estimates from 2015. Survey weighting and imputation were used to obtain national estimates of transfusion-associated adverse events, and the number of units treated with pathogen reduction technology (PRT), screened for Babesia, and leukoreduced. RESULTS The rate of transfusion-associated adverse events requiring any diagnostic or therapeutic interventions was stable (275 reactions per 100,000 transfusions in 2015 and 282 reactions per 100,000 transfusions in 2017). In 2017 among US blood collection centers, 16 of 141 (11.3%) reported screening units for Babesia and 28 of 144 (19.4%) reported PRT implementation; 138 of 2279 (6.1%) hospitals reported transfusing PRT-treated platelets. In 2017, 134 of 2336 (5.7%) hospitals reported performing secondary bacterial testing of platelets (50,922 culture-based and 63,220 rapid immunoassay tests); in 2015, 71 of 1877 (3.8%) hospitals performed secondary testing (87,155 culture-based and 21,779 rapid immunoassay tests). Nearly all whole blood/red blood cell units and platelet units were leukoreduced. CONCLUSIONS Besides leukoreduction, implementation of most blood safety measures reported in this study remains low. Nationally, hospitals might be shifting from culture-based secondary bacterial testing to rapid immunoassays.
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Affiliation(s)
- Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A Henry
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - James J Berger
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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LaVerda D, Shinefeld L, Best N, Lisitu J, Tambolleo G, Vallejo YR. Evaluation of an improved rapid bacterial assay with untreated and pathogen-reduced platelets: Detection of Acinetobacter strains. Transfusion 2021; 61:2710-2717. [PMID: 34042180 PMCID: PMC9291918 DOI: 10.1111/trf.16514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022]
Abstract
Background The PGDprime® test was updated to enable Acinetobacter spp. detection to respond to morbidity and mortality events in 2018 and 2020 involving platelets contaminated with Acinetobacter‐calcoaceticus‐baumannii complex (ACBC). In one morbidity event, the first‐generation PGD test failed to detect ACBC. In two other reported events, pathogen‐reduced (PR) platelets contaminated with ACBC and other bacteria led to patient morbidity and one death. Study Design and Methods A polyclonal antibody to Acinetobacter was integrated in the test device and evaluated for detection of Acinetobacter spp., including the ACBC isolate recovered in one of the 2018 contamination events. Limits of Detection for various Acinetobacter strains were determined in dilution studies. Detection of Acinetobacter growing in platelets after an initial low inoculum was evaluated. Use of the updated test as a secondary test after pathogen reduction was also evaluated by testing at 12‐h intervals PR platelet units inoculated with low levels of the 3 species reported in the fatal PR platelet: ACBC, Staphylococcus saprophyticus, and Leclercia adecarboxylata. Results The test detected several Acinetobacter strains at the clinically relevant CFU/ml levels associated with septic transfusions and successfully detected Acinetobacter growing in various non‐PR platelet types after an initial low inoculum. In PR platelets, the test yielded a positive result with the 3 implicated bacteria in 48 h or less after inoculation, or 48–72 h earlier than the reported time of transfusion of contaminated PR platelets. Conclusion PGDprime was improved to detect Acinetobacter and has shown utility to interdict contaminated PR platelets.
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Affiliation(s)
- David LaVerda
- Research and Development Department, Verax Biomedical Incorporated, Marlborough, Massachusetts, USA
| | - Lisa Shinefeld
- Research and Development Department, Verax Biomedical Incorporated, Marlborough, Massachusetts, USA
| | - Nancy Best
- Research and Development Department, Verax Biomedical Incorporated, Marlborough, Massachusetts, USA
| | - Johny Lisitu
- Research and Development Department, Verax Biomedical Incorporated, Marlborough, Massachusetts, USA
| | - Gary Tambolleo
- Research and Development Department, Verax Biomedical Incorporated, Marlborough, Massachusetts, USA
| | - Yli Remo Vallejo
- Research and Development Department, Verax Biomedical Incorporated, Marlborough, Massachusetts, USA
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21
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Crawford E, Kamm J, Miller S, Li LM, Caldera S, Lyden A, Yokoe D, Nichols A, Tran NK, Barnard SE, Conner PM, Nambiar A, Zinter MS, Moayeri M, Serpa PH, Prince BC, Quan J, Sit R, Tan M, Phelps M, Derisi JL, Tato CM, Langelier C. Investigating Transfusion-related Sepsis Using Culture-Independent Metagenomic Sequencing. Clin Infect Dis 2021; 71:1179-1185. [PMID: 31563940 PMCID: PMC7442849 DOI: 10.1093/cid/ciz960] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Transfusion-related sepsis remains an important hospital infection control challenge. Investigation of septic transfusion events is often restricted by the limitations of bacterial culture in terms of time requirements and low yield in the setting of prior antibiotic administration. METHODS In 3 gram-negative septic transfusion cases, we performed metagenomic next-generation sequencing (mNGS) of direct clinical blood specimens in addition to standard culture-based approaches utilized for infection control investigations. Pathogen detection leveraged IDSeq, a new open-access microbial bioinformatics portal. Phylogenetic analysis was performed to assess microbial genetic relatedness and understand transmission events. RESULTS mNGS of direct clinical blood specimens afforded precision detection of pathogens responsible for each case of transfusion-related sepsis and enabled discovery of a novel Acinetobacter species in a platelet product that had become contaminated despite photochemical pathogen reduction. In each case, longitudinal assessment of pathogen burden elucidated the temporal sequence of events associated with each transfusion-transmitted infection. We found that informative data could be obtained from culture-independent mNGS of residual platelet products and leftover blood specimens that were either unsuitable or unavailable for culture or that failed to grow due to prior antibiotic administration. We additionally developed methods to enhance accuracy for detecting transfusion-associated pathogens that share taxonomic similarity to contaminants commonly found in mNGS library preparations. CONCLUSIONS Culture-independent mNGS of blood products afforded rapid and precise assessment of pathogen identity, abundance, and genetic relatedness. Together, these challenging cases demonstrated the potential for metagenomics to advance existing methods for investigating transfusion-transmitted infections.
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Affiliation(s)
- Emily Crawford
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Department of Microbiology and Immunology, University of California-San Francisco, San Francisco, California, USA
| | - Jack Kamm
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Lucy M Li
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Saharai Caldera
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Division of Infectious Diseases, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Amy Lyden
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Deborah Yokoe
- Division of Infectious Diseases, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.,Department of Hospital Epidemiology and Infection Prevention, University of California-San Francisco, San Francisco, California, USA
| | - Amy Nichols
- Department of Hospital Epidemiology and Infection Prevention, University of California-San Francisco, San Francisco, California, USA
| | - Nam K Tran
- Department of Pathology and Laboratory Medicine, University of California-Davis, Davis, California, USA
| | - Sarah E Barnard
- Department of Pathology and Laboratory Medicine, University of California-Davis, Davis, California, USA
| | - Peter M Conner
- Department of Pathology and Laboratory Medicine, University of California-Davis, Davis, California, USA
| | - Ashok Nambiar
- Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Matt S Zinter
- Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA
| | - Morvarid Moayeri
- Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Paula Hayakawa Serpa
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Division of Infectious Diseases, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Brian C Prince
- Division of Infectious Diseases, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Jenai Quan
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rene Sit
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Michelle Tan
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Maira Phelps
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Joseph L Derisi
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Department of Biochemistry and Biophysics, University of California-San Francisco, San Francisco, California, USA
| | | | - Charles Langelier
- Chan Zuckerberg Biohub, San Francisco, California, USA.,Division of Infectious Diseases, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
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22
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Mowla SJ, Kracalik IT, Sapiano MRP, O'Hearn L, Andrzejewski C, Basavaraju SV. A Comparison of Transfusion-Related Adverse Reactions Among Apheresis Platelets, Whole Blood-Derived Platelets, and Platelets Subjected to Pathogen Reduction Technology as Reported to the National Healthcare Safety Network Hemovigilance Module. Transfus Med Rev 2021; 35:78-84. [PMID: 33934903 DOI: 10.1016/j.tmrv.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
Despite advances in transfusion safety, concerns with safety of platelet transfusions remain including platelet-related sepsis and higher reaction rates observed among patients receiving apheresis platelets (APLTs). National Healthcare Safety Network (NHSN) Hemovigilance Module (HM) data were analyzed to quantify the burden and severity of adverse reactions occurring from APLTs and whole blood-derived platelets (WBD-PLTs). Facilities participating in NHSN HM during 2010-2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for APLTs and WBD-PLTs stratified by severity, use of platelet additive solution (PAS), and pathogen reduction technology (PRT). Chi-square tests were used to compare rates. During the study interval, 2,000,589 platelets were transfused: 1,435,154 APLTs; 525,902 WBD-PLTs; and among APLTs, 39,533 PRT-APLTs. APLT adverse reaction rates were higher (478 vs 70/ 100,000, P< .01) and more often serious (34 vs 6/100,000; P< .01) compared with WBD-PLTs. Adverse reactions were higher among PRT-APLTs (572/100,000) and were less often serious (18/100,000) compared with non-PRT-APLTs (35/100,000) although this association was not statistically significant. Among components implicated in adverse reactions, 92% of APLTs were suspended in plasma. Compared with PRT-APLTs stored in PAS, rates were higher among units stored in plasma (760 vs 525/100,000). Most serious reactions (75%) were allergic. No transfusion-transmitted infections were reported among PRT-APLTs. APLTs were associated with a 6-fold and 2-fold higher serious adverse reaction risks compared with WBD-PLTs and PRT-APLTs, respectively. These findings demonstrate the importance of monitoring transfusion-related adverse reactions to track the safety of platelet transfusions and quantify the impact of mitigation strategies through national hemovigilance systems.
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Affiliation(s)
- Sanjida J Mowla
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Ian T Kracalik
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynne O'Hearn
- Department of Pathology, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Chester Andrzejewski
- Department of Pathology, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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23
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Fadeyi EA, Wagner SJ, Goldberg C, Lu T, Young P, Bringmann PW, Meier NM, Namen AM, Benjamin RJ, Palavecino E. Fatal sepsis associated with a storage container leak permitting platelet contamination with environmental bacteria after pathogen reduction. Transfusion 2020; 61:641-648. [PMID: 33616945 DOI: 10.1111/trf.16210] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pathogen reduction technology and enhanced bacterial culture screening promise to significantly reduce the risk of transfusion-associated septic reactions due to contaminated platelets. Recent reports suggest that these interventions lack efficacy for post-collection and processing contamination with environmental organisms if the storage bag integrity is compromised. CASE REPORT We report a fatal septic transfusion reaction in a 63-year-old patient with chronic kidney and liver disease who received a pathogen reduced platelet transfusion in anticipation of surgery. METHODS The residual platelet concentrate was cultured, with the detected microorganisms undergoing 16S genotype sequencing. Separate pathogen reduction studies were performed on the recovered bacteria, including assessment for amotosalen photoproducts. The storage container was subjected to pressure testing and microscopic examination. Environmental culture screening was performed at the hospital. RESULTS Gram negative rods were detected in the platelet unit and cultures of both platelet component and the patient's blood grew Acinetobacter baumannii complex, Leclercia adecarboxylata and Staphylococcus saprophyticus. These strains were effectively inactivated with >7.2, 7.7, and >7.1 log10 kill, respectively. The platelet storage container revealed a leak visible only on pressure testing. Hospital environmental cultures were negative and the contamination source is unknown. A. baumannii complex and S. saprophyticus 16S genotyping sequences were identical to those implicated in a previously reported septic reaction. CONCLUSION Findings are compatible with post-processing environmental contamination of a pathogen reduced platelet concentrate via a non-visible, acquired storage container leak. Efforts are warranted to actively prevent damage to, and detect defects in, platelet storage containers, and to store and transport components in clean environments.
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Affiliation(s)
- Emmanuel A Fadeyi
- Department of Pathology and Laboratory Medicine, Wake Forest University School of Medicine Winston-Salem, Winston-Salem, North Carolina, USA
| | - Stephen J Wagner
- American National Red Cross, Washington, District of Columbia, USA
| | - Corinne Goldberg
- American National Red Cross, Washington, District of Columbia, USA
| | - Thea Lu
- Cerus Corporation, Concord, California, USA
| | - Pampee Young
- American National Red Cross, Washington, District of Columbia, USA
| | | | - Nathaniel M Meier
- Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew M Namen
- Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Elizabeth Palavecino
- Department of Pathology and Laboratory Medicine, Wake Forest University School of Medicine Winston-Salem, Winston-Salem, North Carolina, USA
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24
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Wang HH, Liao LN, Lin CL, Yen LL, Hsiao YM, Ko JL. Quality validation of platelets obtained from the Haemonetics and Trima Accel automated blood-collection systems. Transfus Clin Biol 2021; 28:44-50. [PMID: 33227455 DOI: 10.1016/j.tracli.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Platelet transfusion is required to treat haemo-oncology or trauma patients. Platelet apheresis (PA) performed with apheresis equipment has increased rapidly in recent years. Leucocyte-reduced platelet apheresis (LRPA) can reduce the risk of platelet refractoriness and febrile nonhemolytic transfusion reactions (FNHTRs) for transfusion. Accordingly, this study aimed to investigate and compare the platelet metabolic and functional responses between PA performed with Haemonetics and LRPA performed with Trima Accel cell separator. METHODS The qualities of platelets collected through PA and LRPA were evaluated in terms of visual appearance, morphology, platelet-aggregation changes, metabolic activities, and bacterium-screening test during 5-day storage. Statistical analyses included two-sample t-test and generalised estimating equation(GEE) method. RESULTS During 5-day storage in LRPA, residual leucocytes were all <1.0×106, and the parameters of platelet function were as follows: platelet aggregated to agonists such as adenosine 5'-diphosphate (ADP) and collagen, and the extent of shape change and pO2 showed no statistically significant difference between PA and LRPA. The hypotonic shock reaction (HSR) on days 0, 1, and 3 were significantly higher in LRPA than in PA (71.78±6.92 vs. 64.10±7.42; P=0.002; 71.53±8.98 vs. 62.96±9.84; P=0.007; 68.05±7.28 vs. 57.76±6.80; P<0.0001, respectively). Values of mean platelet volume (MPV) were statistically larger in PA than in LRPA on days 0, 1, and 3. On day 5, the swirling score was higher in LRPA than in PA. The mean lactate levels had no statistically significant difference between PA and LRPA. Moreover, no growth was observed through bacterium-screening test conducted on 40 samples. CONCLUSION Comparison of LRPA and PA products collected from the Trima Accel and Haemonetics automated blood-collection systems, respectively, revealed that both products possessed good platelet qualities even though additional processes are needed to reduce leucocytes. Furthermore, investigating the outcomes of other apheresis instruments with focus on the safety of donors, products, and recipients is necessary.
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25
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Abe H, Endo K, Nogawa M, Shiba M, Miyata S, Satake M. In vitro thrombus formation and in vivo hemostasis mediated by platelets irradiated with bactericidal ultraviolet C from xenon flash under flow conditions. Transfusion 2020; 61:191-201. [PMID: 33107611 DOI: 10.1111/trf.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported a flow path-ultraviolet C (UVC) irradiation system for platelet concentrates (PCs) with platelet additive solution (PAS) to minimize contamination by bacteria. Here, we investigated functionalities of irradiated platelets (PLTs) in in vitro thrombus formation and in vivo hemostasis. STUDY DESIGN AND METHODS PAS-PCs were irradiated with flash UVC using the flow path system. Their variables (PLT count, mean platelet volume, pH, glucose, lactate, glycoprotein [GP] Ib, and activated integrin αIIbβ3) were evaluated. Static adhesion to collagen or fibrinogen was analyzed using fluorescent microscopy. Thrombus formation under flow conditions was assessed using a collagen-coated bead column. Adenosine diphosphate (ADP)-induced Akt phosphorylation was determined by western blot. In vivo hemostasis and circulatory survival of PLTs were assessed with a rabbit bleeding model. RESULTS All variables, except for GPIb expression, were slightly, but significantly, impaired after flash UVC irradiation throughout the 6-day storage period. No difference was observed in static adhesion to either collagen or fibrinogen between irradiated and nonirradiated PAS-PCs. In vitro thrombus formation of flash UVC-irradiated PAS-PCs was significantly greater than that of nonirradiated PAS-PCs. ADP-induced Akt phosphorylation was enhanced in irradiated PAS-PCs. In vivo hemostatic efficacy was comparable between the groups on Day 1. The efficacy declined in nonirradiated PAS-PCs on Day 5, while it was retained in flash UVC-irradiated PAS-PCs. Circulatory survival of PLTs was lower in irradiated PAS-PCs. CONCLUSIONS PAS-PCs irradiated with UVC from xenon flash have favorable properties to achieve hemostasis compared with nonirradiated PAS-PCs.
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Affiliation(s)
- Hideki Abe
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Kimika Endo
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masayuki Nogawa
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.,Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Shiba
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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26
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Stubbs JR, Homer MJ, Silverman T, Cap AP. The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages. Transfusion 2020; 61:303-312. [PMID: 33098328 DOI: 10.1111/trf.16140] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022]
Abstract
Due to circumstances such as increased demand and an aging donor pool, the likelihood of critical platelet shortages is increasing. The platelet supply could be improved through the expansion of the donor pool, the identification and sustained utilization of high-quality donors, and changes in component processing and storage that result in a longer platelet shelf-life. Refrigerated platelets, stored at 1° to 6°C, have the potential to improve patient safety by decreasing the risk of bacterial contamination while concurrently allowing for a longer storage period (eg, 14 days) and improved hemostatic effectiveness in actively bleeding patients. An approach utilizing remuneration of apheresis platelet donors combined with pathogen reduction of the platelet components could be used as a means to increase the donor pool and identify and sustain safe, reliable, high-quality donors. Remuneration might provide an incentive for underutilized populations (eg, individuals <30 years old) to enter the apheresis platelet donor population resulting in a significant expansion of the platelet donor pool. Over time, approaches such as the use of refrigerated platelets, platelet donor remuneration, and the application of pathogen reduction technology, might serve to attract a large, reliable, and safe donor base that provides platelet collections with high yields, longer shelf-lives and, excellent hemostatic function.
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Affiliation(s)
- James R Stubbs
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary J Homer
- Department of Health and Human Services, Biomedical Advanced Research and Development Authority (BARDA), Washington, DC, USA
| | - Toby Silverman
- Department of Health and Human Services, Biomedical Advanced Research and Development Authority (BARDA), Washington, DC, USA
| | - Andrew P Cap
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, US Army Institute of Surgical Research and Uniformed Services University, JBSA-FT Sam Houston, Texas, USA
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27
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Walker BS, White SK, Schmidt RL, Metcalf RA. Residual bacterial detection rates after primary culture as determined by secondary culture and rapid testing in platelet components: A systematic review and meta-analysis. Transfusion 2020; 60:2029-2037. [PMID: 32757411 DOI: 10.1111/trf.16001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary culture alone was a bacterial risk control strategy intended to facilitate interdiction of contaminated platelets (PLTs). A September 2019 FDA guidance includes secondary testing options to enhance safety. Our objective was to use meta-analysis to determine residual contamination risk after primary culture using secondary culture and rapid testing. STUDY DESIGN AND METHODS A December 2019 literature search identified articles on PLT bacterial detection rates using primary culture and a secondary testing method. We used meta-analysis to estimate secondary testing detection rates after a negative primary culture. We evaluated collection method, sample volume, sample time, and study date as potential sources of heterogeneity. RESULTS The search identified 6102 articles; 16 were included for meta-analysis. Of these, 12 used culture and five used rapid testing as a secondary testing method. Meta-analysis was based on a total of 103 968 components tested by secondary culture and 114 697 by rapid testing. The residual detection rate using secondary culture (DRSC ) was 0.93 (95% CI, 0.24-0.6) per 1000 components, while residual detection rate using rapid testing (DRRT ) was 0.09 (95% CI, 0.01-0.25) per 1000 components. Primary culture detection rate was the only statistically significant source of heterogeneity. CONCLUSION We evaluated bacterial detection rates after primary culture using rapid testing and secondary culture. These results provide a lower and upper bound on real-world residual clinical risk because these methods are designed to detect high-level exposures or any level of exposure, respectively. Rapid testing may miss some harmful exposures and secondary culture may identify some clinically insignificant exposures.
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Affiliation(s)
| | - Sandra K White
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Robert L Schmidt
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan A Metcalf
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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28
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Vallejo RP, Shinefeld L, LaVerda D, Best N, Lawrence G, Lousararian A, Hornbaker N, Rasmusson P, Mintz PD. Performance profile of an updated safety measure rapid assay for bacteria in platelets. Transfusion 2020; 60:2622-2632. [PMID: 32743810 PMCID: PMC7754371 DOI: 10.1111/trf.16000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Verax PGD rapid test for bacteria in platelets (PLTs) has been updated to simplify workflow and improve specificity and sensitivity by employing a novel sequential format. The performance of this updated version, called PGDprime, was evaluated to determine its suitability for use as an FDA-cleared "safety measure" to supplant the current PGD test. STUDY DESIGN AND METHODS Three consecutive cGMP-manufactured lots of PGDprime were evaluated for specificity (at three separate sites), sensitivity, reproducibility, interfering substances, assay robustness, and detection in analytical growth and ultralow-inoculum growth studies. PGDprime's performance was compared to that of PGD. RESULTS Specificity studies yielded no false-positive results among 3802 individual indate PLTs of seven different types (observed specificity, 100%). PGDprime detected all 10 PGD claim bacteria at the same limit of detection or better. Wild-type Gram-negative bacteria growing in PLTs were detected at earlier elapsed times than PGD by 12 to 30 hours. In growth studies, PGDprime detected bacteria growing in PLTs within the same 12-hour interval as PGD or 12 to 48 hours earlier. Assay reproducibility was not affected by operator, day of test, or manufacturing lot. PGDprime tolerated a wide variation in volume transfers, timing, temperature, and relative humidity and was not affected by 15 of 16 potential interferents found in samples at extremely high or low levels. CONCLUSION The PGD test has been successfully updated to PGDprime with an innovative sequential assay format to deliver a robust simplified workflow and improved specificity and sensitivity.
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Affiliation(s)
- Remo P Vallejo
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Lisa Shinefeld
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - David LaVerda
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Nancy Best
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Gregory Lawrence
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Adam Lousararian
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Nancy Hornbaker
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Patricia Rasmusson
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
| | - Paul D Mintz
- Research and Development Department, Verax Biomedical Incorporated, Worcester, Massachusetts, USA
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29
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Abstract
PURPOSE OF REVIEW In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets. RECENT FINDINGS Recent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study. SUMMARY Our review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.
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30
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Fridey JL, Stramer SL, Nambiar A, Moayeri M, Bakkour S, Langelier C, Crawford E, Lu T, Lanteri MC, Kamm J, Miller S, Wagner SJ, Benjamin RJ, Busch MP. Sepsis from an apheresis platelet contaminated with Acinetobacter calcoaceticus/baumannii complex bacteria and Staphylococcus saprophyticus after pathogen reduction. Transfusion 2020; 60:1960-1969. [PMID: 32738079 DOI: 10.1111/trf.15951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Strategies to reduce platelet (PLT) bacterial contamination include donor screening, skin disinfection, sample diversion, bacterial culture, pathogen reduction (PR), and day-of-transfusion tests. We report bacterial sepsis following a pathogen-reduced PLT transfusion. CASE REPORT An adult male with relapsed acute lymphoblastic leukemia was successfully treated for central catheter-associated Staphylococcus aureus bacteremia. A peripherally inserted central catheter (PICC) was placed. Chills, rigors, and flushing developed immediately after PICC-infused pathogen-reduced PLTs, progressing to septic shock requiring intensive care management. METHODS PICC and peripheral blood (PB), transfused bag saline flushes (TBFs), environmental samples, and the pathogen-reduced untransfused co-component (CC) were cultured. Plasma metagenomic and bacterial isolate whole-genome sequencing; PLT mitochondrial DNA (mtDNA) testing of untransfused CC and TBF; CC testing for amotosalen (S-59)/S-59 photoproducts; isolate PR studies (INTERCEPT); and TBF polymerase chain reaction for recipient Y-chromosome DNA were performed. RESULTS PB and PICC cultures grew Acinetobacter calcoaceticus/baumannii complex (ACBC). TBF was gram-positive; mass spectrometry identified ACBC and Staphylococcus saprophyticus (SS). CC Gram stain and cultures were negative. Environmental cultures, some done after decontamination, were ACBC/SS negative. Posttransfusion patient plasma and TBF ACBC sequences were genetically identical. No Y-chromosome signal was detected in TBF. S-59 photoproducts and evidence of mtDNA amplification inhibition were found in the CC. Spiking PR studies showed >5.9-log inactivation for both isolates. Donor skin cultures for Acinetobacter were negative. CONCLUSION CC sterility, PR studies, residual S-59 photoproducts, and mtDNA amplification inhibition suggest successful PR. Unidentified environmental sources and inherent or acquired bag defects may have contributed to postmanufacturing pathogen-reduced PLT contamination.
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Affiliation(s)
- Joy L Fridey
- Southern California Region, American Red Cross, Pomona, California, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Ashok Nambiar
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Morvarid Moayeri
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, USA
| | - Charles Langelier
- Chan Zuckerberg Biohub, University of California San Francisco, San Francisco, California, USA
| | - Emily Crawford
- Chan Zuckerberg Biohub, University of California San Francisco, San Francisco, California, USA
| | - Thea Lu
- Cerus Corporation, Concord, California, USA
| | | | - Jack Kamm
- Chan Zuckerberg Biohub, University of California San Francisco, San Francisco, California, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Stephen J Wagner
- Transfusion Innovation, American Red Cross, Rockville, Maryland, USA
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31
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Pagano MB, Allen ES, Chou ST, Dunbar NM, Gniadek T, Goel R, Harm SK, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Raval JS, Schwartz J, Shan H, Spinella PC, Storch E, Cohn CS. Current advances in transfusion medicine: a 2019 review of selected topics from the AABB Clinical Transfusion Medicine Committee. Transfusion 2020; 60:1614-1623. [PMID: 32472580 DOI: 10.1111/trf.15848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION. STUDY DESIGN AND METHODS CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine. CONCLUSION This synopsis provides easy access to relevant topics and may be useful as an educational tool.
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Affiliation(s)
- Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ruchika Goel
- Transfusion Medicine Division, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Sarah K Harm
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jay S Raval
- Transfusion Medicine Service, Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Transfusion Medicine & Cellular Therapy, Department of Pathology & Cell Biology, Columbia University, New York, New York
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California
| | - Philip C Spinella
- Division of Pediatric Critical Care, Washington University in St Louis, St Louis, Missouri, USA
| | - Emily Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland
| | - Claudia S Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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Kundrapu S, Srivastava S, Good CE, Lazarus HM, Maitta RW, Jacobs MR. Bacterial contamination and septic transfusion reaction rates associated with platelet components before and after introduction of primary culture: experience at a US Academic Medical Center 1991 through 2017. Transfusion 2020; 60:974-985. [PMID: 32357261 DOI: 10.1111/trf.15780] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The high incidence of septic transfusion reactions (STRs) led to testing being mandated by AABB from 2004. This was implemented by primary culture of single-donor apheresis platelets (APs) from 2004 and prestorage pooled platelets (PSPPs) from 2007. STUDY DESIGN/METHODS Platelet (PLT) aliquots were cultured at issue and transfusion reactions evaluated at our hospital. Bacterial contamination and STR rates (shown as rates per million transfusions in Results) were evaluated before and after introduction of primary culture by blood centers that used a microbial detection system (BacT/ALERT, bioMerieux) or enhanced bacterial detection system (eBDS, Haemonetics). RESULTS A total of 28,457 PLTs were cultured during pre-primary culture periods (44.7% APs; 55.3% at-issue pooled PLTs [AIPPs]) and 97,595 during post-primary culture periods (79.3% APs; 20.7% PSPPs). Forty-three contaminated units were identified in preculture and 34 in postculture periods (rates, 1511 vs. 348; p < 0.0001). Contamination rates of APs were significantly lower than AIPPs in the preculture (393 vs. 2415; p < 0.0001) but not postculture period compared to PSPPs (387 vs. 198; p = 0.9). STR rates (79 vs. 90; p = 0.98) were unchanged with APs but decreased considerably with pooled PLTs (826 vs. 50; p = 0.0006). Contamination (299 vs. 324; p = 0.84) and STR rates (25 vs. 116; p = 0.22) were similar for PLTs tested by BacT/ALERT and eBDS primary culture methods. A change in donor skin preparation method in 2012 was associated with decreased contamination and STR rates. CONCLUSION Primary culture significantly reduced bacterial contamination and STR associated with pooled but not AP PLTs. Measures such as secondary testing near time of use or pathogen reduction are needed to further reduce STRs.
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Affiliation(s)
- Sirisha Kundrapu
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Swati Srivastava
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Caryn E Good
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robert W Maitta
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael R Jacobs
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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33
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Lu W, Delaney M, Flegel WA, Ness P, Ratcliffe N, Triulzi DJ, Yazer MH, Ziman A, Dunbar NM. How do you… decide which platelet bacterial risk mitigation strategy to select for your hospital-based transfusion service? Transfusion 2020; 60:675-681. [PMID: 32027394 PMCID: PMC7131880 DOI: 10.1111/trf.15693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 01/12/2023]
Abstract
The United States Food and Drug Administration Final Guidance for Industry titled, "Bacterial Risk Control Strategies for Blood Collection Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion" provides nine strategies for platelet bacterial risk mitigation. Even if it is assumed all strategies are comparable in terms of safety and efficacy, the decision of which to implement remains challenging. Some additional factors that warrant evaluation before selecting a strategy include the financial impact, process for implementation, logistics upon implementation, institutional acceptance by blood bank staff, administration and clinicians, and effect on platelet availability. To assist with this difficult choice, a panel of transfusion service physicians who have expertise on the topic and have already selected strategies for their transfusion services were recruited to provide varied perspectives. In addition, the use of a decision-making tool that objectively evaluates defined criteria for assessment of the nine strategies is described.
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Affiliation(s)
- Wen Lu
- Robert Tomsich Pathology & Laboratory Medicine
Institute, Cleveland Clinic, Cleveland, Ohio
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children’s
National Medical Center, Washington, DC
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center,
National Institutes of Health, Bethesda
| | - Paul Ness
- Department of Pathology, Johns Hopkins University School of
Medicine, Baltimore, Maryland
| | - Nora Ratcliffe
- Pathology & Laboratory Medicine, White River Junction
VA Medical Center, White River Junction, Vermont
| | - Darrell J. Triulzi
- Centralized Transfusion Service, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Mark H. Yazer
- Centralized Transfusion Service, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service,
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine,
University of California Los Angeles, Los Angeles, California
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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34
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Abe H, Endo K, Shiba M, Niibe Y, Miyata S, Satake M. Flow path system of ultraviolet C irradiation from xenon flash to reduce bacteria survival in platelet products containing a platelet additive solution. Transfusion 2020; 60:1050-1059. [DOI: 10.1111/trf.15757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/09/2020] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hideki Abe
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | - Kimika Endo
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | - Masayuki Shiba
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | | | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
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35
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Abstract
Allogeneic platelets collected for transfusion treated with pathogen reduction technology (PRT), which has been available in some countries for more than a decade, are now increasingly available in the United States (US). The implementation of PRT-treated platelets, also known as pathogen-reduced platelets (PRPs), has been spurred by the need to further decrease the risk of sepsis associated with bacterial contamination coupled with the potential of this technology to reduce the risk of infections due to already recognized, new, and emerging infectious agents. This article will review available PRP products, examine their benefits, highlight unresolved questions surrounding this technology, and summarize pivotal research studies that have compared transfusion outcomes (largely in adult patients) for PRPs with non-PRT-treated conventional platelets (CPs). In addition, studies describing the use of PRPs in pediatric patients and work done on the association between PRPs and HLA alloimmunization are discussed. As new data emerge, it is critical to re-evaluate the risks and benefits of existing PRPs and newer technologies and reassess the financial implications of adopting PRPs to guide our decision-making process for the implementation of transfusing PRPs.
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Affiliation(s)
- Wen Lu
- Section of Transfusion Medicine, Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
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Nevala-Plagemann C, Powers P, Mir-Kasimov M, Rose R. A Fatal Case of Septic Shock Secondary to Acinetobacter Bacteremia Acquired from a Platelet Transfusion. Case Rep Med 2019; 2019:3136493. [PMID: 32089699 DOI: 10.1155/2019/3136493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 01/05/2023] Open
Abstract
Background Transfusion of blood products is a frequent and often necessary lifesaving intervention. While changes to blood bank practices over the past several decades have reduced the infectious complications associated with transfusions, risks still exist. Septic transfusion reactions caused by bacterial contamination of blood products, especially platelets, still occur relatively frequently. Unfortunately, clinical recognition of septic transfusion reactions is difficult due to significant symptom, exam, and laboratory abnormality overlap between different types of transfusion reactions, as well as other conditions. Novel methods have been developed to detect blood product contamination but have yet to be widely implemented in the United States. Case Report A 67-year-old male with chronic thrombocytopenia was transfused with platelets prior to a planned procedure. Shortly afterwards, he developed fever and hypotension. He was transferred to the intensive care unit where he was treated with aggressive fluid resuscitation and broad-spectrum antibiotics. The patient went on to develop progressively worsening shock and profound disseminated intravascular coagulation. Blood cultures from the patient and the transfused platelets grew an Acinetobacter species. Despite aggressive resuscitative efforts and appropriate antibiotics, the patient died approximately 48 hours following the transfusion reaction. Conclusion We report a fatal case of septic shock associated with Acinetobacter bacteremia caused by platelet transfusion. Our review of the literature revealed only one other documented platelet transfusion associated fatality caused by Acinetobacter species. Novel pathogen reduction and contamination detection methods have been developed but have yet to be widely adopted in the United States.
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Emery A, Marpaux N, Naegelen C, Valot B, Morel P, Hocquet D. Genotypic study of Citrobacter koseri, an emergent platelet contaminant since 2012 in France. Transfusion 2019; 60:245-249. [PMID: 31804713 DOI: 10.1111/trf.15617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transfusion-transmitted bacterial infection is a rare occurrence but the most feared complication in transfusion practices. Between 2012 and 2017, five cases of platelet concentrates (PCs) contaminated with the bacterial pathogen Citrobacter koseri (PC-Ck) have been reported in France, with two leading to the death of the recipients. We tested the possibilities of the emergence of a PC-specific clone of C. koseri (Ck) and of specific bacterial genes associated with PC contamination. STUDY DESIGN AND METHODS The phylogenetic network, based on a homemade Ck core genome scheme, inferred from the genomes of 20 worldwide Ck isolates unrelated to PC contamination taken as controls (U-Ck) and the genomes of the five PC-Ck, explored the clonal relationship between the genomes and evaluated the distribution of PC-Ck throughout the species. Along with this core genome multilocus sequence typing approach, a Ck pan genome has been used to seek genes specific to PC-Ck isolates. RESULTS Our genomic approach suggested that the population of C. koseri is nonclonal, although it also identified a cluster containing three PC-Ck and eight U-Ck. Indeed, the PC-Ck did not share any specific genes. CONCLUSION The elevated incidence of PCs contaminated by C. koseri in France between 2012 and 2017 was not due to the dissemination of a clone. The determinants of the recent outbreaks of PC contamination with C. koseri are still unknown.
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Affiliation(s)
- Audrey Emery
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France
| | - Nadine Marpaux
- Etablissement Français du Sang Bourgogne-Franche-Comté, UMR1098, Besançon, France
| | - Christian Naegelen
- Etablissement Français du Sang Bourgogne-Franche-Comté, UMR1098, Besançon, France
| | - Benoît Valot
- UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France.,Big Data et Bioinformatique au Service de la Santé, UFR Sciences de la Santé, Université de Bourgogne Franche-Comté, Besançon, France
| | - Pascal Morel
- Etablissement Français du Sang Bourgogne-Franche-Comté, UMR1098, Besançon, France
| | - Didier Hocquet
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France.,UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France.,Big Data et Bioinformatique au Service de la Santé, UFR Sciences de la Santé, Université de Bourgogne Franche-Comté, Besançon, France.,Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France
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38
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Bahar B, Schulz WL, Gokhale A, Spencer BR, Gehrie EA, Snyder EL. Blood utilisation and transfusion reactions in adult patients transfused with conventional or pathogen-reduced platelets. Br J Haematol 2019; 188:465-472. [PMID: 31566724 PMCID: PMC7003815 DOI: 10.1111/bjh.16187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/27/2019] [Indexed: 01/23/2023]
Abstract
Pathogen-reduced (PR) platelets are routinely used in many countries. Some studies reported changes in platelet and red blood cell (RBC) transfusion requirements in patients who received PR platelets when compared to conventional (CONV) platelets. Over a 28-month period we retrospectively analysed platelet utilisation, RBC transfusion trends, and transfusion reaction rates data from all transfused adult patients transfused at the Yale-New Haven Hospital, New Haven, CT, USA. We determined the number of RBC and platelet components administered between 2 and 24, 48, 72 or 96 h. A total of 3767 patients received 21 907 platelet components (CONV = 8912; PR = 12 995); 1,087 patients received only CONV platelets (1578 components) and 1,466 patients received only PR platelets (2604 components). The number of subsequently transfused platelet components was slightly higher following PR platelet components (P < 0·05); however, fewer RBCs were transfused following PR platelet administration (P < 0·05). The mean time-to-next platelet component transfusion was slightly shorter following PR platelet transfusion (P = 0·002). The rate of non-septic transfusion reactions did not differ (all P > 0·05). Septic transfusion reactions (N = 5) were seen only after CONV platelet transfusions (P = 0·011). These results provide evidence for comparable clinical efficacy of PR and CONV platelets. PR platelets eliminated septic transfusion reactions without increased risk of other types of transfusions with only slight increase in platelet utilisation.
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Affiliation(s)
- Burak Bahar
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Wade L Schulz
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Amit Gokhale
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Eric A Gehrie
- Department of Pathology and Laboratory Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward L Snyder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
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