Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

Heather A. Hume, Henry Ddungu, Racheal Angom, Hannington Baluku, Henry Kajumbula, Dorothy Kyeyune-Byabazaire, Jackson Orem, Sandra Ramirez-Arcos, Aaron A Tobian

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA). STUDY DESIGN AND METHODS: This prospective, observational study evaluated the rate of BC in whole blood–derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions. RESULTS: In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3% to 2.1% (according to criteria used to define BC). The Gram stain had high specificity (99.1%) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78% of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3% (95% confidence interval, 3.7%-12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. CONCLUSIONS: The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.

Original languageEnglish (US)
Pages (from-to)1951-1959
Number of pages9
JournalTransfusion
Volume56
Issue number8
DOIs
StatePublished - Aug 1 2016

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Platelet Transfusion
Africa South of the Sahara
Blood Platelets
Uganda
Therapeutics
Platelet Count
Observational Studies
Transfusion Reaction
Prospective Studies
Confidence Intervals
Staining and Labeling
Hemorrhage
Anti-Bacterial Agents
Safety
Gram's stain
Neoplasms

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)
  • Hematology

Cite this

Platelet transfusion therapy in sub-Saharan Africa : bacterial contamination, recipient characteristics, and acute transfusion reactions. / Hume, Heather A.; Ddungu, Henry; Angom, Racheal; Baluku, Hannington; Kajumbula, Henry; Kyeyune-Byabazaire, Dorothy; Orem, Jackson; Ramirez-Arcos, Sandra; Tobian, Aaron A.

In: Transfusion, Vol. 56, No. 8, 01.08.2016, p. 1951-1959.

Research output: Contribution to journalArticle

Hume, HA, Ddungu, H, Angom, R, Baluku, H, Kajumbula, H, Kyeyune-Byabazaire, D, Orem, J, Ramirez-Arcos, S & Tobian, AA 2016, 'Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions', Transfusion, vol. 56, no. 8, pp. 1951-1959. https://doi.org/10.1111/trf.13594
Hume, Heather A. ; Ddungu, Henry ; Angom, Racheal ; Baluku, Hannington ; Kajumbula, Henry ; Kyeyune-Byabazaire, Dorothy ; Orem, Jackson ; Ramirez-Arcos, Sandra ; Tobian, Aaron A. / Platelet transfusion therapy in sub-Saharan Africa : bacterial contamination, recipient characteristics, and acute transfusion reactions. In: Transfusion. 2016 ; Vol. 56, No. 8. pp. 1951-1959.
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abstract = "BACKGROUND: Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA). STUDY DESIGN AND METHODS: This prospective, observational study evaluated the rate of BC in whole blood–derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions. RESULTS: In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3{\%} to 2.1{\%} (according to criteria used to define BC). The Gram stain had high specificity (99.1{\%}) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78{\%} of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3{\%} (95{\%} confidence interval, 3.7{\%}-12.7{\%}) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. CONCLUSIONS: The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.",
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T1 - Platelet transfusion therapy in sub-Saharan Africa

T2 - bacterial contamination, recipient characteristics, and acute transfusion reactions

AU - Hume, Heather A.

AU - Ddungu, Henry

AU - Angom, Racheal

AU - Baluku, Hannington

AU - Kajumbula, Henry

AU - Kyeyune-Byabazaire, Dorothy

AU - Orem, Jackson

AU - Ramirez-Arcos, Sandra

AU - Tobian, Aaron A

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N2 - BACKGROUND: Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA). STUDY DESIGN AND METHODS: This prospective, observational study evaluated the rate of BC in whole blood–derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions. RESULTS: In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3% to 2.1% (according to criteria used to define BC). The Gram stain had high specificity (99.1%) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78% of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3% (95% confidence interval, 3.7%-12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. CONCLUSIONS: The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.

AB - BACKGROUND: Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA). STUDY DESIGN AND METHODS: This prospective, observational study evaluated the rate of BC in whole blood–derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions. RESULTS: In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3% to 2.1% (according to criteria used to define BC). The Gram stain had high specificity (99.1%) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78% of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3% (95% confidence interval, 3.7%-12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. CONCLUSIONS: The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.

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