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Blood and Blood Products : Infections


Case Synopsis

A 70-year-old man with a history of coronary artery disease and a new diagnosis of abdominal aortic aneurysm is being evaluated in the preoperative area for an open repair. His hemoglobin is 10 g/dL, and you decide to obtain his informed consent for the possibility of blood product transfusions. During the process of obtaining consent, he becomes visibly upset during the discussion. On further questioning, it becomes clear that the patient is very concerned over the chance of “catching something from the blood” and would like to know more information.

Problem Analysis

Definition

Blood-borne infections are a concern of patients, family members, and health care providers alike. Patients may be exposed to these infections through the transfusion of banked blood products. Additionally, the act of allogeneic blood transfusion alone may cause recipient immunomodulation that can confer an increased risk of infections. As the largest user of blood products of any physician group, it is especially important for the anesthesiologist to understand the risks of infections and their management.

Transfusion-transmitted infectious diseases (TTIDs) have been recognized for decades, with the most recent advances occurring since the 1980s and the discovery of blood-related human immunodeficiency virus (HIV) transmission. Blood products can transmit viral, bacterial, and parasitic infections. Several mechanisms are in place throughout the donation process to mitigate these risks, including donor screening and testing.

Recognition

The blood screening process begins with a medical history to detect patients with symptoms of current infections and those at high risk of carrying infection. Donated blood is then tested for several viral and parasitic pathogens through antibody and nucleic acid testing ( Box 100.1 ). Additionally, donor platelets are subjected to an automated culture for 24 hours after donation to screen for bacterial contamination. Several notable infectious agents not tested for but known to be transmissible include variant Creutzfeldt-Jakob disease, malaria, dengue fever, and babesiosis. These are typically screened for during the blood donation interview process.

BOX 100.1
Infectious Agents Tested for in Donated Blood Products
Adapted from Goodnough LT: Blood management: transfusion medicine comes of age. Lancet 381(9880):1791-1792, 2013.

  • Human immunodeficiency virus types 1 and 2

  • Human T-cell lymphotropic virus types 1 and 2

  • Hepatitis B virus

  • Hepatitis C virus

  • West Nile virus

  • Cytomegalovirus

  • Syphilis (Treponema pallidum)

  • Chagas disease (Trypanosoma cruzi) —only for first-time donors

Bacterial Infections

Transfusion-transmitted bacterial infections (TTBIs) are more common in platelet components, owing to their room-temperature storage. TTBIs can be caused from a wide spectrum of organisms during the collection process, including donor blood or contamination during phlebotomy collection and subsequent processing. Both gram-positive and gram-negative organisms have been shown to grow in platelets, with the most common pathogen being Yersinia enterocolitica.

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