Platelet Product Contamination

Estimated risk of sepsis related to apheresis platelets is 1:2000. This risk is greater with transfusions of pooled platelet concentrates from multiple donors. Because the risk of bacterial overgrowth increases with time, the shelf life of platelets stored at 20-24°C is limited to 5 d. The organisms implicated most commonly in fatalities, in descending order, are Staphylococcus aureus, Klebsiella pneumoniae, Serratia marcescens, and Staphylococcus epidermidis (6).

Clinical presentation of infection with bacterially contaminated platelets can range from mild fever (potentially indistinguishable from febrile, nonhemolytic transfusion reactions) to acute sepsis, hypotension, and death. Sepsis caused by transfusion of contaminated platelets is unrecognized in part because the organisms found in platelet contamination are frequently the same as those implicated in catheter-related sepsis. The overall mortality rate of identified platelet-associated sepsis is 26% (6). In the clinical setting, any patient developing fever within 6 h of receiving a platelet transfusion should be evaluated, and empiric antibiotic therapy should be considered.

No widely accepted test is used to detect bacterially contaminated blood products. One promising approach is pathogen inactivation, such as the use of psoralen and ultraviolet (UV) light to sterilize blood products (11). The use of this technology is associated with decreased platelet recovery and in vivo survival, however, leading to the need for increased platelet transfusions (12,13).

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