A CASE OF TRANSFUSION RELATED BACTERIAL INFECTION M. Germain MD, J. Lollazolo MD, S. Saito MD Department of Medicine, LSU Health Sciences Center, New Orleans, LA CASE:
A 32-year-old woman with a history of myelodysplastic syndrome with multiple transfusions presented with a 7-day course of increasing shortness of breath, fatigue, dyspnea on exertion, pallor and chest pain. The patient was alert and cooperative, tired appearing, had generalize pallor with pale conjunctiva. She was also noted to bemildly tachycardic. Labs were positive for a hemoglobin of 4.2 and a hematocrit of 11. She was started on an infusion of packed red blood cells. About 20 minutes into the infusion, she began to complain of increased SOB and chest pain and felt ill, having multiple episodes of emesis and diarrhea. She then developed rigors and spiked a fever of 105.1, became profoundly tachycardic and hypotensive and was given epinephrine, diphenhydramine and solu-medrol. Repeat labs included CBC, LDH, haptoglovin, d-diner, fribrinogen, Direct Antiglobulin Test, and procalcitonin. She had a hemoglobin of 3.9, WBC count of 0.4 with absolute neutrophil count of 300, and pro-cal of 524. She was started on epinephrine infusion, then switched to levophed and started on antibiotics. The transfused blood was tested again for compatibility and it was thought that patient could safely resume transfusions and tolerated them well. Gram stain on the transfused blood demonstrated Gram-negative rods in addition to Gram-positive cocci, and cultures of the transfused blood grew Rahnella aquatilis and Pseudomonas fluroesence . The patient’s blood cultures never grew. DISCUSSION: Transfusion reactions are a relatively common occurrence; they can range from mild to severe and life threatening. Transfusion emergencies include TACO and TRALI, as well as hemolytic reactions. Transfusion related sepsis is a rare but documented adverse reaction (~1:5million). In immunocompetent patients, Rahnella aquatilis is a relatively weak pathogen found in fresh water. There are, however, other documented cases of patients who become septic from this microorganism. Pseudomonas fluroesence is also a relatively weak pathogen, but case reports illustrate that this organism can be a source of bacteremia in patients who received contaminated infusions.
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