In September 2009 a six year old girl undergoing treatment for a rare form of cancer in USA died after platelet transfusion. According to a lawsuit brought by her family, the cause wasn’t cancer, but septic shock from a contaminated platelet transfusion!
Doctors say that after during her treatment for cancer she was doing well and receiving low-dose chemotherapy and routine maintenance treatments. But during a checkup, because her platelets were low, a transfusion was ordered. That sent her into septic shock and while antibiotics killed the bacteria, she suffered organ failure and after nine days suffered a massive stroke. Ten days after the transfusion she died in her mother’s arms.
BACKGROUND
Although on first glance this may seem as a one off incident due the negligence of hospital and blood bank authorities, a study proved otherwise. In a study of over four million platelet units the Red Cross (in USA) collected and distributed to hospitals from January 2007 to December 2011, it found 381 suspected septic reactions in platelets it distributed, 38 definite or probable cases and four deaths. The report also claims that platelet contamination is the No. 1 infection risk in the U.S. blood supply. Unfortunately though there is no data available for India. Though most transfusions are safe and well-tolerated, new safety standards adopted by some blood banks have reduced the average rate of fatalities from sepsis, or blood poisoning. Still, hundreds of nonfatal sepsis cases and other adverse reactions are still linked to contaminated platelets.
WHAT IS PLATELET CONTAMINATION?
A growing number of studies show that standard tests performed by blood banks before they ship platelets to hospitals miss the majority of contaminated platelets. Unlike other blood components such as red cells, which are refrigerated, platelets must be stored at room temperature to remain effective, but during storage periods that last up to five days bacteria can grow and multiply.
Platelets can become contaminated if the donor has even a low-grade blood infection, or when the skin isn’t properly cleaned, drawing surface bacteria into the platelets during collection. Since 2004 efforts are being made to detect and limit bacteria, generally by taking cultures of donated platelets to measure bacteria growth within 24 to 48 hours. But bacteria levels may be too low that early for detection, and studies show as many as 1 in 1,000 units that tested negative were actually contaminated
HOW CAN PLATELET CONTAMINATION BE DETECTED?
According to a July 30 2012 report published in the Wall Street Journal, about 150 hospitals in America have adopted a new contamination test, for platelets. This is a test that can be administered immediately before patients get a transfusion. Initially approved in 2007, it has one major barrier cost: It adds about $25 to $30 to the average cost of a unit of platelets.
Other steps to improve safety are diverting some initial blood drawn from the donor into a separate pouch to capture any skin bacteria, and swirling blood bags to visually spot signs of contamination. Hospitals should also watch patients for signs of infection such as fever and chills after a transfusion, and administer antibiotics if needed.
Reference: AABB Journal, Wikipedia, Wall Street Journal article on health