Transfusion services should have clear policies describing the required investigations for transfusion complications. An example of an immediate investigation shows steps that could be used to investigate any immediate transfusion reaction.
Bacterial sepsis needs to be differentiated from complications that share some similar symptoms such as immediate hemolytic transfusion reactions, TRALI, and febrile non-hemolytic transfusion reactions. The immediate management of the patient as well as recommendations for reporting the reaction and the management of future transfusions are different for each of these complications.
CSA Standard Z902-04, Blood and Blood Components pertaining to investigating bacterial sepsis should be followed. Patient survival depends on
- early recognition
- stopping the transfusion
- rapidly beginning appropriate treatment
Below is an example of a protocol suitable for laboratory investigation of a case of suspected bacterial sepsis. Individuals should always adhere to the policies developed in their institutions.
Laboratory Investigation
In bacterial sepsis hemoglobinemia and hemoglobinuria may be present. Visible examination of the RBC unit may show discolouration (darkening) of the red cell unit, bubbles, hemolysis, or clots.
To diagnose transfusion-related bacterial sepsis, promptly perform a Gram's stain on the remaining donor unit and aerobic and anaerobic cultures on the
- recipient
- implicated donor unit or units (bag, not segments)
- IV solutions (if applicable)
If little of the transfused component remains, culture media may be injected directly into the blood bag. Blood samples from the recipient, the blood container(s) and the transfusion set filter should be collected in a manner to avoid external contamination. The blood container should be refrigerated, and both the blood container and the bacterial isolates should be saved until an investigation can be completed.
A diagnosis of transfusion-related bacterial sepsis is proven by the isolation of the same organism in the donor unit and recipient.
