YERSINIA-ENTEROCOLITICA TRANSMISSION FROM A RED-CELL UNIT 34 DAYS OLD

In 1993 the North London Blood Transfusion Centre received its first r eport of Yersinia enterocolitica transmission from a unit of red cells supplied to a local hospital. The recipient was a 23-year-old male wh o was neutropenic following a third cycle of chemotherapy for treatmen t of acute myeloblastic leukaemia (FAB type M6) and received a 34-day- old red cell unit. During transfusion the patient developed septicaemi a and endotoxin-mediated shock. The transfusion was stopped immediatel y and broad spectrum antibiotics administered immediately on suspicion of bacteraemia from the transfused unit. This prompt action undoubted ly prevented a fatal outcome. Y. enterocolitica was isolated from the blood bag. Antibody was also detected in the bag and in a sample taken from the donor 39 days post-donation. Antibody to serotype 03 was ide ntified, the commonest serotype reported in transfusion-transmitted Y. enterocolitica. The donor reported no gastrointestinal upset or illne ss prior to donation. This transfusion reaction might not have occurre d had the red cells been transfused earlier in their storage period, b ut would not have been prevented by the exclusion of donors with a his tory of gastrointestinal illness as the donor was asymptomatic. Nor wo uld it have been prevented by inspecting the blood for a change in col our, as no such change was observed. Y. enterocolitica is a significan t problem in transfusion medicine and transmission is generally associ ated with a high mortality rate. Hospitals should be urged to investig ate bacteriologically all appropriate transfusion reactions so that th e true extent of the problem in the United Kingdom can be assessed.