Regular Article TRANSFUSION MEDICINE Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance

• Bacterial sepsis from contaminated platelet transfusions continues to occur despite recent interventions; additional measures are needed. • STR to platelet transfusion is frequently not recognized or reported; use of recent AABB criteria showed highest diagnostic sensitivity. Septic transfusion reactions (STRs) resulting from transfusion of bacterially contaminated platelets are a major hazard of platelet transfusion despite recent interventions. Active and passive surveillance for bacterially contaminated platelets was performed over 7 years (2007-2013) by culture of platelet aliquots at time of transfusion and review of reported transfusion reactions. All platelet units had been cultured 24 hours after collection and releasedasnegative.FivesetsofSTRcriteriawereevaluated, includingrecentAABBcriteria; sensitivity and specificity of these criteria, as well as detection by active and passive surveillance, were determined. Twenty of 51 440 platelet units transfused (0.004%; 389 per million) were bacterially contaminated by active surveillance and resulted in 5 STRs occurring 9 to 24 hours posttransfusion; none of these STRs had been reported by passive surveillance.STRoccurredonly inneutropenicpatients transfusedwithhighbacterial loads. A total of 284 transfusion reactions (0.55%) were reported by passive surveillance. None of these patients had received contaminated platelets. However, 6 to 93 (2.1%-32.7%) of these 284 reactions met 1 or more STR criteria, and sensitivity of STR criteria varied from 5.1% to 45.5%. These results document the continued occurrence of bacterial contamination of platelets resulting inSTR inneutropenicpatients, failureofpassivesurveillance todetectSTR, and lackofspecificityofSTRcriteria. These findingshighlight the limitationsof reportednationalSTRdatabasedonpassivesurveillanceand theneed to implement furthermeasures to address this problem such as secondary testing or use of pathogen reduction technologies. (Blood. 2016;127(4):496-502)