Transfusion reaction culture

[WisKnow]

Hello there!

 

Should culture on units sent back to the blood bank post transfusion reaction be performed by a blood bank tech or be sent to Microbiology since Microbiology staff are trained better as far as blood culture aseptic technique is concerned?

[Malcolm Needs ☆]

I would send them to Microbiology every time.  As you quite correctly say, they are the people who are trained in this area.

[WisKnow]

I would send them to Microbiology every time.  As you quite correctly say, they are the people who are trained in this area.

Thanks Malcolm! That was exactly what we were doing in my previous hospital but the hospital I am in now has an SOP in place that dictates we should be the one to do the inoculation process and submit the inoculated bottles and an aliquot for gram stain to Micro. I am not sure if this is a requirement imposed by the CAP, AABB or FDA because this hospital closely adheres to the accrediting and regulatory agencies' requirements. If this is not, how do the other hospitals do it? I am interested to know other hospitals' SOP on this.

Edited July 26, 2015 by WisKnow

[MERRYPATH]

Infection Control is where the information is directed. Blood Bankers makes a smear and culture bottles (aerobic and anaerobic-which are sent to micro) from the remains of the unit and from a tube drawn post-reaction, retypes the patient and does the DAT...what happens from that point varies with results.

Edited July 26, 2015 by MERRYPATH

[David Saikin]

All my techs are generalists and can plant these cultures when indicated.

[tbostock]

Micro should do it.

[goodchild]

Our procedure is for micro to do it, but they end up calling me upstairs to help them every time because it's such a rare thing.

[Sko681]

MIcro for sure.  They have a procedure for it. 

[Eoin]

Like David, we cover all disciplines - so up to scientist investigating possible reaction (or TTI).

[AMcCord]

We let Micro do it on days. We do take them the bag, but that's as far as we go.  Evening and night shift techs are generalists and will do the inoculation - after I've told them to and told them how to do it - they are not good on deciding things like that for themselves. It's a rare thing for us, too. I know of no regulatory requirement that would dictate that Blood Bank does it.

[SMILLER]

I am not sure about which department should do the culture but it seems to me that, like all Lab work, the important thing is that person planting the culture and gramstain and whatnot, better be documented as being qualified to do that part of the C&S procedure.

 

Scott

[izzyfig]

We order the the transfusion culture but leave the rest for micro to handle.

[jayinsat]

In all honesty, there is no "one size fits all" answer here.  It depends on how the facility operates.  Smaller facilities that are staffed by generalists will differ than larger, specialized facilities.  You have to do what works for your environment.  Your procedures should clearly reflect what your facility does.

[jojo808]

The blood banker does it at our hospital. We use a sampling site coupler by Fenwal to spike the donor unit. From there you cleanse the rubber port on the coupler and obtain your blood sample for culture, all the time using aseptic technique. You can use a syringe with a needle or needleless cannula to access the rubber port.  

[Malcolm Needs ☆]

29 minutes ago, jojo808 said:

The blood banker does it at our hospital. We use a sampling site coupler by Fenwal to spike the donor unit. From there you cleanse the rubber port on the coupler and obtain your blood sample for culture, all the time using aseptic technique. You can use a syringe with a needle or needleless cannula to access the rubber port.  

BUT, if you are doing this yourself, do you let your supplier know of your suspicions, so that they can put any other blood components/products manufactured from the same unit into quarantine until you have your results.

[amym1586]

 

On ‎7‎/‎27‎/‎2015 at 6:42 AM, David Saikin said:

All my techs are generalists and can plant these cultures when indicated.

Same here.

[MAGNUM]

Since transfusion reactions are a rarity here, we plant all units from suspected reactions and they are generally planted by the blood banker who just so happens to also be a generalist.

[pinktoptube]

Is it necessary to culture all suspected transfusion reactions? The supplier cultures the components already and unless the reaction has sepsis like symptoms why bother?

[Eagle Eye]

Most reactions at our place do not get culture done. Once the reaction work up is completed we notify our medical director and he/she decides if she wants to send for culture, mostly based on signs and symptoms and patient's underlying conditions.

[heathervaught]

2 hours ago, pinktoptube said:

Is it necessary to culture all suspected transfusion reactions? The supplier cultures the components already and unless the reaction has sepsis like symptoms why bother?

The only components that are routinely cultured are platelets.  Red cells and plasma are not.  And there is always a possibility that contamination occurs that is not related to the product, for example infusion set or solutions.

[tbostock]

9 hours ago, Eagle Eye said:

Most reactions at our place do not get culture done. Once the reaction work up is completed we notify our medical director and he/she decides if she wants to send for culture, mostly based on signs and symptoms and patient's underlying conditions.

Same here

[pinktoptube]

20 hours ago, heathervaught said:

The only components that are routinely cultured are platelets.  Red cells and plasma are not.  And there is always a possibility that contamination occurs that is not related to the product, for example infusion set or solutions.

We have a pathologist who insists on a culture for every reaction...

[jojo808]

On 1/21/2016 at 0:00 AM, Malcolm Needs said:

BUT, if you are doing this yourself, do you let your supplier know of your suspicions, so that they can put any other blood components/products manufactured from the same unit into quarantine until you have your results.

No it's not really a suspicion, just a part of our protocol. We culture all suspected transfusion reactions. Hmmm .. reading the responses and not sure if it's overkill. In over 25 years we've only had one positive culture. It was before using the fenwal coupler device. We used to "bleed" the tubing that was used for transfusion, to get our micro specimen for culture. In that incident, the patient had a UTI from Klebsiella. She eventually became septic with Klebsiella PRIOR to transfusion. The culture came back positive for Klebsiella. Fortunately after we cultured the contents inside the original bag (we sent the whole bag to micro at this point), nothing grew out. We found out that the nurse took the blood bag, laid it on the bedside table for a few minutes while phoning the MD for possible transfusion reaction. She then clamped it off after phoning the MD. It was concluded the Klebsiella was from the backflow of blood from the patient's arm into the tubing.  Thank goodness the order of events were clearly tracked and documented.  

[Eagle Eye]

too me culturing all transfusion is definitely overkill. It should be based on sign and symptoms, patient's clinical condition and Pathologist review.

[AMcCord]

We are going change policy to do blood cultures on the patient and bag if the patient symptoms include an increase in temp. In discussing this with our Medical Director we talked about collecting the culture only after pathology review, but decided to draw it up front with the rest of the specimen for the reaction workup. We didn't want to stick the patient again unless we had to and we decided that drawing the specimen during the temp spike (if possible) was the best timing for the culture. It is probably overkill, but he thought that overall it would be the most effective. We don't do many workups so it is not going to be a burden to Micro. (And yes, the majority of reactions called here are for an increase in temp.)