Transfusion-associated sepsis

Adverse events related to transfusion of blood components have been reported, including febrile non-hemolytic transfusion reactions, mild febrile reactions, acute and delayed hemolytic transfusion reactions, transfusion-related acute lung injury (TRALl), anaphylactic and other allergic reactions, graft-versus-host disease (GvHD), transfusion-associated circulatory overload (TACO), viral infections, post-transfusion bacteremia, transfusion-associated sepsis (TAS), hemosiderosis, post-transfusion purpura, and new allo-antibody formation [18 , 19 ]. Whole blood, erythrocytes, leukocytes, platelets, and plasma for transfusion (fresh frozen plasma, FFP) are involved. Quite a number of these adverse effects, such as TRALl, TACO, TAS, and allergic/anaphylactic reactions can be difficult to evaluate. 

Thrombocytopenia also developed in a 72-year-old man who was treated with vancomycin for staphylococcal sepsis after treatment with gemcitabine for metastatic pancreatic cancer (53). On day 12 thrombocytopenia developed, reached a nadir on day 18 (13 x lO /l), and did not respond to platelet transfusions. Bone-marrow megakaryocjrtes were adequate. Platelet-associated IgG and IgM were increased. Vancomycin was withdrawn on day 28, with prompt recovery of the platelet count to 136 x lO /l in 10 days. 

Observational studies In a retrospective cohort analysis, using an intensive care unit database, of the effect of antithrombin III compared with standard therapy on outcomes and erythrocyte transfusion rates in 545 postoperative surgical patients with severe sepsis, antithrombin III therapy was associated with a significantly higher frequency of erythrocyte transfusion (22 versus 9 units) there was no beneficial effect on mortality [37 ]. 

---