University of Tennessee Medical Center, Tennessee, United States
Background/Case Studies: Platelet products, with their relatively short shelf life, have always been a challenge for hospitals trying to balance, maintaining an adequate supply, while minimizing waste. Platelets are also stored at room temperature, which increases the risk of bacterial proliferation. Providing safe, uncontaminated platelet products is vital for providing the best care for patients. To address these issues, the FDA released a guidance document in December of 2020 with several bacterial risk control strategies directed at decreasing the incidence of transfusion associated bacterial infections.
Beginning in October of 2021, our institution began using two separate platelet products to meet our hospital’s demands, apheresis platelets that have undergone large volume, delayed sampling (LVDS) no sooner than 48 hours, and Acrodose, pooled, whole blood derived platelets (WBD).
After implementing LVDS platelets our institution noticed several platelets that were positive for C. acnes.
Study
Design/Methods: Retrospective transfusion data was reviewed on platelets transfused from October 14th, 2021 to October 1st, 2022. The platelets were surveyed for units that had a positive alert from our blood supplier or positive cultures from transfusion reaction workups. This data included product type (LVDS single donor platelet unit vs Acrodose WBD), age of platelet on transfusion, and method of bacterial detection.
Results/Findings: Within our data, we found 10 possible contaminated platelets. 9 LVDS SDP (from 8 different donations) were identified as having positive BACT alerts from our blood supplier. Of the 9 total LVDS SDP platelet units having positive BACT alerts, 3 resulted in no growth after culture. These were determined to be false positives. Of the remaining 6 platelet units, 5 grew C. acnes, and 1 grew Corynebacterium. As determined from a post transfusion culture after a reported transfusion reaction, 1 WBD platelet was positive, which grew S. hominis and S. parasanguinis. All the LVDS platelets were transfused on day 5 or day 6, and all the BACT alerts from the blood center occurred after the units were transfused. None of the LVDS contaminated platelets resulted in any adverse effects in the patients. The one WBD platelet resulted in a non-fatal, septic transfusion reaction. Conclusions: While the increased sensitivity of new culturing methods is detecting more bacterially contaminated platelets, for certain bacteria, such as C. acnes, there is not yet enough data outlining the clinical relevance of transfusing this organism. While we have not yet had any adverse events related to C. acnes, as a precaution we have decided to implement secondary bacterial culture on all platelets on days 5, 6, and 7.
Importance of research: We herein present these findings in the interest of discussing the clinical significance of these findings, and the possible implications if this is not an isolated finding at our institution.
