Transfusion-transmitted Klebsiella pneumoniae fatalities, 1995 to 2004.

Transfusion-transmitted bacterial sepsis is the third most common cause of transfusion-related fatalities reported to the Food and Drug Administration. Between October 1, 1995, and September 30, 2004, there were 665 reported transfusion fatalities. Eighty-five (13%) deaths were due to transfusion-transmitted bacterial infections, of which 58 (68%) were due to gram-negative organisms. The most common gram-negative organism associated with transfusion-transmitted deaths after receipt of platelets was Klebsiella pneumoniae. This article summarizes retrospectively the case series of deaths due to transfusion-transmitted K pneumoniae infection, reported to the Food and Drug Administration, 1995 to 2004. There were 12 deaths due to transfusion-transmitted K pneumoniae infection with 7 (58%) of the 12 cases occurring in 2002. Eleven deaths were caused by the transfusion of contaminated platelets and 1 death attributed to contaminated red blood cells. Extensive review of the seven 2002 fatality reports did not identify a common (shared) lot for items used during collection or processing of the blood product. In conclusion, in cases of suspected transfusion-transmitted septicemia, broad spectrum antibiotic coverage including coverage of gram-negative organisms should be considered. Strict adherence to infection control measures while collecting, processing, and handling all blood and blood components in both the clinical settings and in the laboratory should be followed. Further development of simple and effective test procedures for detecting bacteria in the blood is needed.

Fatalities caused by TRALI.

This article includes a retrospective review of fatalities caused by transfusion-related acute lung injury (TRALI) over a 5-year period (from 1997 to 2002) that were reported to the Center for Biologics Evaluation and Research involving 58 recipient deaths and the corresponding 63 blood component donors. Descriptive statistics are presented. Recipient characteristics include age, sex, and admitting diagnosis. Cardiovascular disease, pulmonary disorders, and cancer were the most frequent diagnoses of transfusion recipients. Reported deaths did not appear to be associated with age, sex, reason for transfusion, or transfusion component. Implicated blood component(s) and clinical symptoms at the time of reaction were recorded. Fresh frozen plasma was implicated in one half of the cases, whereas red blood cells played a role in approximately one third. The clinical characteristics described most often in TRALI reports included shortness of breath, frothy sputum, pulmonary infiltrates, and hypoxia. Donor variables included age, sex, parity, and laboratory tests for antibodies to HLA and/or antigranulocyte antibodies. Laboratory tests showed HLA antibodies and/or antigranulocyte antibodies were positive in the majority of donors tested. More data are needed to better describe the role of antibodies in these reactions. Greater awareness is crucial for the practitioner to be alert for signs and symptoms of TRALI and to be aware of the necessary steps in treatment.