Transfusion Risks

Question 1

What measures in Canada minimise the risk of transmitted an infectious disease in transfusions?

Answer 1

Blood collection from unpaid volunteers
Donor interview and selection protocol
The diversion of the first 40 ml of blood collected into a diversion pouch
Donor screening by serological and other tests (bacterial detection in platelets)
Viral inactivation procedures (plasma derived products)
Leukocyte reduction techniques

Question 2

What is the goal of leukocyte reduction?

Answer 2

Decrease the risk of white cell-associated viruses such as CMV and HTLV type I/II

Question 3

Can you do solvent/detergent and heat inactivated procedures on RBCs?
What do these procedures treat?

Answer 3

No. These procedures are not tolerated by platelets or PRBCs. It can only be done on plasma.

Heat - CMV, HAV, HBV, HIV, WNV, parvovirus
Solvent/detergent - CMV, HBV, HCV, HIV

Question 4

What type of product are Factor VIII and XI? Is there a risk of infection

Answer 4

Recombinant.
Not plasma-derived
No risk

Question 5

Which has greater risk of bacterial contamination, platelets or PRBCs? Why?

Answer 5

Platelets

Because they are stored at room temperature.

Question 6

What is done to minimise the risk of bacterial contamination specifically for platelets?

Answer 6

Aliquot diversion

Bacterial detection - automated culture of platelet components

Question 7

Why is bacterial contamination of FFP and cryoprecipitates lower?

Answer 7

These components are frozen, and usual microbes are killed by freezing and other storage conditions

Question 8

In the past, frozen plasma components used to get bacterial contamination from the thawing procedure, that involved a water bath. How have we changed the procedures to minimise the risk of contamination?

Answer 8

We have used a microwave technique and designed special coverings for the bags

Question 9

What system in Canada surveils transfusions problems?

Answer 9

The Transfusion Transmitted Injuries Surveillance System

it captures 80% of transfusions in Canada

Question 10

What are the possible transfusion adverse events, apart from infection?

Answer 10

Circulatory overload (46%)
Anaphylactic/anaphylactoid reactions (16%)
Hypotensive reactions (12%)
Transfusion-related acute lung injury (8%)
Acute haemolytic transfusion reaction
Delayed haemolytic transfusion reaction
Post-transfusion purpura

Question 11

What is the risk of transmitting an infection?

Answer 11

1:3000000

Similar risk to being hit by lightning

Question 12

What bacteria are at risk of contamination?

Answer 12

Yersinia
Pseudomonas
Skin flora: staph aureas and staph epidermis (plasma and platelets)
Salmonella (platelets)
E Coli (platelets)
Enterococci (platelets)
clostridium (platelets)
Serretia (platelets)

Question 13

What is the risk of HIV with transfusion?

Answer 13

1:8-12 million