Regarding a possible transfusion reaction, what symptoms would you use to determine when to set up a culture on the unit and do you perform a gram stain immediately? Also, how much of an increase in temperature would you consider a need to set up a culture?

Heather Wester, M.T.(ASCP)

BSA Healthcare System

Amarillo, Tx.

Our procedure states to do blood culture, no gram stain, for the following symptoms: fever (defined as >2.0F rise), chill, and shaking chills. On occasion, the pathologist will request one for other symptoms.

Hi Heather,

We culture unit (no gram) by sampling (aseptic technique into unused port) & then transferring into culture bottles. We use >1.5C rise, with or without appropriate symptoms.

There have been papers re contamination during this process, so worth looking for & considering (don't have a reference to hand). Important to consider - because the question arises was it a contaminant entering the patient from contaminated unit - or was it introduced during the testing of the unit? The good news is that we have had a low hit rate for positive cultures, but they do obviously occur. There is also a need to consider patient's underlying co-morbid conditions.

Good luck with it.

Cheers

Eoin

Edited June 24, 201114 yr by Eoin

Following the recommendation of an inspector, we started doing gram stains and cultures on the units of all suspected tx reactions. This does delay reporting the completed work-up, but if we discover anything unexpected in the workup we contact the patient's physician immediately.

:peaceman::peaceman::peaceman::peaceman::peaceman:

This is our policy:

3.2.1.8.1 If there is a febrile reaction (>2 degree F temperature rise) or a possible septic reaction, do a gram stain on the unit bag per MIC-315. If the gram stain is positive, culture the bag according to procedure (MIC-315).

We perform a bacterial contamination workup immediately, without waiting for our pathologist's request, when the temperature rises 4 degree F above the baseline. The standard orders are for a stat gram stain of the unit, blood cultures on the unit and blood cultures on the patient. The floor is to be called to order the blood culture of the patient immediately and also to draw the blood from a separate access than that used for the IV access line used to transfuse the patient. This is to eliminate the possibility of a bacteria coming from a contaminated IV access line. Also, the patient's blood culture should not be delayed as antibiotic therapy may be started from the increased temperature seen during transfusion. A bacterial contamination workup can also be ordered by the pathologists during his/her review of the transfusion eraction work up and is often requested when symptoms are rigors and chills with a rise in temp > 2 degrees F.

If there is a positive gram stain result, this is immediately called to the floor, to the pathologist and to the blood bank manager. It is one of our panic values.

Edited June 27, 201114 yr by conwaysbb
misspelling

Oh yes, sorry we do blood cultures on the patient as well.

Cheers

Eoin

I have heard of using a 4 degree F rise and/or a temp of 104F or shaking chills with either fever indicator as indicators for culture.

My question is not when to do a blood culture, but what plates to set up. I have heard many sugestions but can find nothing in the way of regulations. We currently just inoculate a Aero/ Anero blood culture bottle for the Bac-T, but have heard that plates should be set up as well.

Hi everyone,

I am looking for suggestions........

my medical director RARELY requests blood cultures on units classified as febrile reactions because a large section of our transfused patients are treated surgically and non-surgically for infected joints.

Many patients have low grade fevers to start with, and despite pre-medication, spike their temperature anyway......usually attributed to their infectious state.

Does anyone know of any way to stratify this patient population in order to assess a fever likely to be a sequelae of the transfusion vs their infectious state?

Thanks in advance.....Linda :cool:

For which plates to set up, take the FDA's annual list of bugs that caused fatalities due to contaminated blood to a microbiologist and do whatever they say it takes to grow those bugs. I'm pretty sure they all grow in blood culture medium. I never could figure out why blood bankers write instructions on how to grow bugs instead of just using the microbiologist's expertise. Years ago, I read some BB text stating that some of the cultures should be grown in the frig but the microbiologists know how to grow Yersinia without sticking plates in the frig.

As for diagnosing, have you tried looking at the CDC's new guidelines for transfusion reactions. (I'll confess I can't remember the details of the infection page.) They might help you stratify your patient population. Otherwise, I would use the >4F rise or > 104F fever as an "always culture" indicator with judgment on other cases.