a blood donor with bacteraemia
TRANSCRIPT
-
8/8/2019 A Blood Donor With Bacteraemia
1/1
Case Report
A 56-year-old woman with a history of well-controlledinsulin-dependent diabetes mellitus and hypertensiondonated platelets in July, 2004. She had donated plateletsapproximately 50 times in the previous 5 and a half years.We did routine testing for bacterial contamination, andcultured Streptococcus bovis from the units she donated,114 hours after incubation. We contacted the woman todiscuss this result, and she reported no additional medicalhistory. She had never had a colonoscopy, and weencouraged her to see her doctor for follow-up. Wedestroyed the units from her donation, and told her that
she could not donate until she was cleared of not havingan obvious source of S bovis bacteraemia. Her doctorordered two sets of blood cultures to look for persistentbacteraemia. These cultures were negative. The womanthen had a colonoscopy that showed a friable mass, 3 cmdiameter, in the sigmoid colon. Sigmoidectomy was donein September, 2004, for moderately differentiatedadenocarcinoma. The woman tolerated surgery well, andhad no complications.
The major cause of platelet contamination is usuallynormal skin flora,1 which can be introduced at the time ofblood collection. Donor bacteraemia is less likely, thoughit can occur after dental manipulation such as tooth
extraction, tooth brushing, or use of gum irrigationdevices.1 S bovis is not typical skin flora or a ubiquitousenvironmental agent. S bovis bacteraemia has been foundin association with gastrointestinal neoplasia (rangingfrom colonic polyps to cancer), extracolonic malignancies,liver disease, endocarditis, cholangitis, meningitis, anddiabetes mellitus.24 The American Society of Hematologyand American Association of Blood Banks has publishedguidelines on the regulation of bacterial contamination ofblood components,1 recently updated to include measuresto detect and limit bacterial contamination in all plateletcomponents.5 Bacterial sepsis related to transfusion is thesecond most frequent transfusion-related cause offatalities in the USA.5
Specific identification of bacterial organisms found intesting of platelet donations can have value to the donor,in addition to the obvious benefit for any potentialrecipient or for quality control. Bacterial culture in thisapparently healthy blood donor led to a timely diagnosis ofmalignancy, and a good clinical outcome.
References1 Hillyer CD, Josephson CD, Blajchman MA, et al. Bacterial
contamination of blood components: risks, strategies, andregulation: joint ASH and AABB educational session intransfusion medicine. Hematology (Am Soc Hematol Educ Program)2003: 57589
2 Gold JS, Bayar S, Salem RR. Association ofStreptococcus bovisbacteremia with colonic neoplasia and extracolonic malignancy.Arch Surg2004; 139: 76065.
3 Lee RA, Woo PCY, To APC, et al. Geographical difference ofdisease association in Streptococcus bovis bacteraemia.
J Med Microbiol 2003;52:
90308.4 Jean SS, Teng LJ, Hsueh PR, et al. Bacteremic Streptococcus bovis
infections at a university hospital, 19922001.J Formos Med Assoc2004; 103: 11823.
5 Centers for Disease Control and Prevention (CDC). Fatalbacterial infections associated with platelet transfusionsUnited States, 2004. MMWR Morb Mortal Wkly Rep 2005; 54:16870.
A blood donor with bacteraemia
Marcia D Haimowitz, Louis A Hernandez, Ross M Herron JrLancet 2005; 365: 1596
American Red Cross Blood
Services (M D Haimowitz MD,
R M Herron Jr MD), Southern
California Region, 100 Red
Cross Circle, Pomona, CA
91768, USA; and Kaiser
Permanente
(L A Hernandez MD),
Southern California, CA, USA
Correspondence to:
Dr Marcia Haimowitz
1596 www.thelancet.com Vol 365 April 30, 2005
Science
PhotoL
ibra
ry
Rights were not granted to includethis image in electronic media.
Please refer to the printed journal.