A PROSPECTIVE-STUDY OF SYMPTOMATIC BACTEREMIA FOLLOWING PLATELET TRANSFUSION AND OF ITS MANAGEMENT

Background: The danger of bacteremia due to contaminated platelets is not well known. There are also no established guidelines for the manag ement of febrile reactions after platelet transfusion. Study Design an d Methods: To determine the risk of symptomatic bacteremia after plate let transfusion, 3584 platelet transfusions given to 161 patients afte r bone marrow transplantation were prospectively studied. Platelet bag s were routinely refrigerated for 24 hours after transfusion. Septic w ork-up was initiated for a temperature rise of more than 2 degrees C a bove the pretransfusion value within 24 hours of platelet transfusion or a temperature rise of more than 1 degrees C that was associated wit h chills and rigor. Diagnosis of bacteremia after platelet transfusion was made only when the pairs of isolates from the blood and the plate let bags were identical with respect to their biochemical profile, ant ibiotic sensitivity, serotyping, or ribotyping. Results: Thirty-seven febrile reactions, as defined above, occurred. Bacteremia subsequent t o platelet transfusion was diagnosed in 10 cases. There was a 27-perce nt chance (95% CI, 15-43%) that these febrile reactions represented ba cteremia that resulted from platelet transfusion. For a subgroup of 19 patients with a temperature rise of more than 2 degrees C, the risk o f bacteremia was 42 percent (95% CI, 23-64%). Septic shock occurred in 4 of the 10 bacteremic patients. A rapid diagnosis was possible becau se the involved bacteria were demonstrated by direct Gram stain of the samples taken from the platelet bags of all 10 patients. Conclusion: Significant febrile reactions after platelet transfusion are highly li kely to be indicative of bacteremia. Routine retention of platelet bag s for subsequent microbiologic study was useful in the investigation o f these febrile reactions. Empiric antibiotic therapy is indicated.