Transfusion Reaction Cultures

[scodina]

Does anyone know if there is data to support rinsing an empty bag with saline and culturing the saline following a suspected septic transfusion reaction? We are in the process of overhauling our transfusion reaction SOP and this question came up.

[RR1]

Sorry- I can't help you with your specific question, however what I would really like to know on a similar topic is when do you determine a blood bag needs to be sent for cultures? Do you do this for every suspected HTR or are there set indicators for this.

Many thanks

[Malcolm Needs ☆]

Sorry- I can't help you with your specific question, however what I would really like to know on a similar topic is when do you determine a blood bag needs to be sent for cultures? Do you do this for every suspected HTR or are there set indicators for this.

Many thanks

Sorry scodina, I am in the same position as Rashmi over this one; I haven't got a clue either.

Having been at a meeting on Friday, however, I can answer Rashmi's question a little more fully.

In most cases, a reaction caused by microbiological contamination strongly resembles a full blown acute immediate transfusion reaction. Therefore, in such a case, if you cannot detect any serological reason for the reaction, suspect microbiological contamination immediately, and let your blood supplier know immediately, so that any other blood components made from the same donation can be put into quarantine immediately.

An awful lot of "immediatelys" here, but speed is of the essence.

:)

[RR1]

Thanks Malcolm, so are we saying that Microbial cultures are not necessary to perform in-house in these cases and should only ever be referred to the blood supplier?

I only asked this as I keep coming across various doc on the internet from UK labs that state 'send blood for cultures/ gram stains' as part of the routine T.R investigation process.

[Malcolm Needs ☆]

Thanks Malcolm, so are we saying that Microbial cultures are not necessary to perform in-house in these cases and should only ever be referred to the blood supplier?

I only asked this as I keep coming across various doc on the internet from UK labs that state 'send blood for cultures/ gram stains' as part of the routine T.R investigation process.

Well, what I am saying is that if there is any suspicion whatsoever that there is microbiological involvement, the blood supplier should be informed immediately.

As to who should perform the culture, I think it would be best to get a decision from the blood supplier's Microbiological Consultant at the time, rather than me trying to say here, and probably making a complete horlicks and getting the answer wrong! (NOT that unusual, as you know!).

:eek::eek:

[RR1]

Well, what I am saying is that if there is any suspicion whatsoever that there is microbiological involvement, the blood supplier should be informed immediately.

As to who should perform the culture, I think it would be best to get a decision from the blood supplier's Microbiological Consultant at the time, rather than me trying to say here, and probably making a complete horlicks and getting the answer wrong! (NOT that unusual, as you know!).

:eek::eek:

Yes, that sounds very sensible. This really means our medics need to be involved at the initial stage of the the suspected transfusion reaction to clarify the testing required.

I don't recall the last time you have messed up...you're O.K really!!! and I really appreciate this 'brainstorming' questions with you and others on the site.

[Malcolm Needs ☆]

Yes, that sounds very sensible. This really means our medics need to be involved at the initial stage of the the suspected transfusion reaction to clarify the testing required.

I don't recall the last time you have messed up...you're O.K really!!! and I really appreciate this 'brainstorming' questions with you and others on the site.

I'm going to print this post and frame it!!!!!!!!

:D:D:D:D

[rravkin@aol.com]

Dear Scodina, Rasmi, and Malcolm,

Quite a volly of posts here. I can say that I have never hard of a practice where the recovered blood bag from a suspected HTR was washed with saline and cultured. I would suspect that any fluid left in the bag would be cultured if deemed nessessary. As part of our work-up the recovered blood bag and any tubing is placed on the quarantine shelf until the physicians involved make thier discisions.

[Eagle Eye]

Same here. We do not send all bags for suspected transfusion for culture. Our medical director reviews the reaction symptoms and workup and makes decision to send the bag for culture.

[kate murphy]

We do not culture every bag for every reaction. Usually for a suspected septic reaction, most of the blood is returned to us.

We do occasionally culture an empty bag. We rinse with 10ml thio broth, and innoculate blood culture bottles.