Hospital Samaritano Blood Bank and Transfusion Service - Grupo Vita São Paulo, Sao Paulo, Brazil
Background/Case Studies: Platelet (PLT) transfusions carry high risks of infection than any other blood product, are limited resource and subject to inventory shortages. PLTs are tested using different methods demanding blood centers ensure enough flexibility to allow for cost-effective plans for a robust inventory. Although we are not allowed to have 7 days PLT in Brazil due our legislation, as we are AABB members we evaluated a method using secondary bacterial culture (SBC) to contend with residual risk of bacterial contamination. Our objective is described how implementation of SBC in order to attend AABB bulletin #21-02 has impact our routine after one year.
Study
Design/Methods: Apheresis PLTs were collected and sampling was undertaken at 24 hours after collection. Primary bacterial culture was performed as follows: PLTs were sampled aseptically using a sample kit (sterile connection device – TSCD- Terumo and fistula needle) and inoculated 8mL into an aerobic bottle BD BACTEC Plus Aerobic/F and BD BACTEC Plus Anaerobic/F, after 5 days PLTs are transfused. Implementation of SBC started in May 2022, at day 3 pos collection, PLTs were sampled using a sampling kit and inoculated 8mL into an aerobic bottle BD BACTEC Plus Aerobic/F. Inoculated bottles were loaded into the BacT/ALERT FX TOP incubator modules and incubated at 35 ± 1 ºC for 5 days or until positive. To perform SBC we had to increase PLT inventory and developed new strategies for donor recruitment, review and create documents as exclusion policies in the case PLTs has to be used before finish culture. The costs of SBC were calculated based on the purchase pricing for consumables (acquisition of new BacT/ALERT with more units, sampling kits and blood culture bottles) showing a financial increase of US$ 4.000 per year.
Results/Findings: Comparing the period from May 2021 to April 2022 with the period after SBC from May 2022 to April 2023 yielding 0 positive results for both periods. In the first period we produced 4204 PLTs, 100% had bacterial culture yielding 0 positive. In the second period we produced 2752 PLTs, 100% bacterial culture even with SBC, remained yielding 0 positive. To analyze these results we must consider Brazilian legislation don’t allow 7 days for PLTs only 5. Our results showed that if your protocol for bacterial contamination is safe, using aerobic and anaerobic bottles in the first screening with a history of 0 positive results, maybe SBC is not applicable. Conclusions: Association bulletin #21-02 is a guide with key points for the AABB members to consider. As AABB member we promptly attend choosing SBC as bacterial risk control strategies, as we do not use pathogen reduction and there is no universally accepted approach to mitigate the residual risk of bacterially contaminated PLTs. SBC in our service did not contribute to increase the barrier for positive culture in the analyzed period but increased the costs of the procedure.
Importance of research: Platelets transfusion always need more attention about bacterial contamination. This work brings data from SBC implantation after one year and the relation with Brazilian platelet legislation that is only 5 days.
