Transfusion-associated circulatory overload (TACO) is a potentially life-threatening complication that can occur with the transfusion of any blood component, and accounts for up to 24% of ...transfusion-associated patient fatalities. This article discusses how to develop evidence-based continuing education and guideline recommendations that will increase nursing staff awareness of TACO and guide nurses in prevention and prompt intervention.
RhD alloimmunization from platelet transfusions have been documented in the literature. However, non-RhD platelet alloimmunization is much less frequent and the risk for non-RhD alloimmunization from ...platelets is thought to be extremely low and most associated with buffy coat pooled platelets. A 22-month-old male with acute myeloid leukemia received 99 mL apheresis platelets for thrombocytopenia. Three months later, an antibody screen, the direct antiglobulin test (DAT), and red blood cell (RBC) genotype were sent for laboratory evaluation. The antibody screen was positive, with anti-E identified. The DAT was negative and the RBC genotype of the patient was predicted to be negative for the E antigen whereas the platelet donor was predicted to be positive for E antigen. There is a risk of alloimmunization of non-RhD antigen from platelet pheresis transfusion even in a patient less than 2 years old.
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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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Hemorrhagic shock is the leading cause of survivable death in trauma patients and recent literature has focused on resuscitation strategies including transfusing low‐titer group O whole ...blood (LTOWB). Debate remains regarding whether leukocyte reduced (LR) whole blood is of clinical benefit or detriment to patients requiring massive transfusion. This study compares survival outcomes between LR‐LTOWB and non‐LR LTOWB.
Study Design and Methods
The objective of this prospective, observational study was to detect any difference in 24‐hour survival between patients receiving LR‐LTOWB and non‐LR LTOWB during their massive transfusion activation. Secondary objectives were to report any difference in ICU LOS, ventilation days, in‐hospital survival, and hospital LOS. Data collected included patient sex, age, mechanism of injury, Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), cause of death, and number of LTOWB transfused.
Results
A total of 167 patients received 271 LTOWB transfusions. There were 97 patients that received 168 units of LR‐LTOWB while 70 patients received 103 units of non‐LR LTOWB. The two study groups were comparable in terms of age, sex, ISS, TRISS, and the number of LTOWB transfused. The use of LR LTOWB during the initial massive transfusion activation in traumatically injured patients was not associated with increased 24‐hour survival compared to when using non‐LR LTOWB. No transfusion associated adverse events were reported.
Conclusions
The administration of either LR or non‐LR LTOWB was not associated with >24 hours survival in patients presenting with massive hemorrhage. The high cost and the rapid decline in platelet count of LR whole blood may be a consideration.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background and Objectives
The use of group A thawed 24‐h plasma when resuscitating haemorrhagic shock patients has become more common; however, limited data exist on the clinical use of liquid plasma ...(LP). Our aim is to determine whether LP is of clinical benefit to patients requiring massive transfusion.
Materials and Methods
The objective of this retrospective study was to detect any difference in 24‐h survival between patients receiving liquid or thawed plasma (TP) during their massive transfusion activation. Other objectives were to report any difference in hospital length of stay (LOS), intensive care unit (ICU) LOS and in‐hospital survival. Data collected included gender, age, mechanism of injury, Injury Severity Score, Revised Trauma Score and Trauma Injury Severity Score.
Results
A total of 178 patients received 1283 units of LP, median 4 and range (1–56), whereas 270 patients received 2031 units of TP, median 5 and range (1–87). The two study groups were comparable in terms of gender, age, mechanism of injury, whole blood, red blood cells, platelets and cryoprecipitate transfused. The use of LP during the massive transfusion activation in traumatically injured patients was not associated with increased 24‐h survival compared to when using TP, p = 0.553.
Conclusion
Our study did not show a difference in 24‐h or 30‐day survival between the use of LP compared to TP in trauma patients. LP should be considered an alternative to TP in trauma patients requiring immediate plasma resuscitation.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
BACKGROUND
The objective was to report a successful implementation of a blood cooler insert and tracking technology with educational initiatives and its effect on reducing red blood cell (RBC) ...wastage.
STUDY DESIGN AND METHODS
The blood bank database was used to quantify and categorize total RBC units issued in blood coolers from January 2010 to December 2015 with and without the new inserts throughout the hospital. Radiofrequency identification tags were used with special software to monitor blood cooler tracking. An educational policy on how to handle the coolers was initiated. Data were gathered from the software that provided a real‐time location monitoring of the blood coolers with inserts throughout the institution.
RESULTS
The implementation of the blood cooler with inserts and tracking device reduced mean yearly RBC wastage by fourfold from 0.64% to 0.17% between 2010 and 2015. The conserved RBCs corresponded to a total cost savings of $167,844 during the 3‐year postimplementation period.
CONCLUSIONS
The implementation of new blood cooler inserts, tracking system, and educational initiatives substantially reduced the mean annual total RBC wastage. The cost to implement this initiative may be small if there is an existing institutional infrastructure to monitor and track hospital equipment into which the blood bank intervention can be adapted when compared to the cost of blood wastage.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract
Anti-S is an IgG antibody and a rare cause of hemolytic disease of the fetus and newborn. A 38 year old woman with blood group O Rh-positive presented to the hospital at 30 weeks gestation. ...Her past medical history was significant for sickle cell disease and alloantibodies against the Fya, Jkb, and S antigens. Obstetric ultrasound showed the fetus to have developed scalp edema, cardiomegaly, small pericardial effusion, and large ascites. Periumbilical blood sampling results showed the fetus blood type as blood group O Rh-positive with anti-S and hemoglobin of 2 gm/dL. After multiple intrauterine transfusions of red blood cells, the fetal hemoglobin increased to 12.9 g/dL. Anti-S can cause fetal hydrops, although it is rare. All pregnant women with anti-S should be closely monitored and treated during pregnancy for the possibility of developing a severe hemolytic disease of the fetus and newborn.
