Bacterial contamination of platelet products is a serious risk of transfusion. As many as 1 in every 1000 units may be contaminated from the introduction of low concentrations of skin bacteria at the time of donation, less commonly from asymptomatic underlying infection at time of donation or rarely during processing.1 In the United States, transfusion-associated sepsis has been recognized and culture-confirmed in at least 1 of 100,000 recipients, and has led to immediate fatal outcome in 1 in 500,000 recipients.2 The actual risk of transfusion-associated sepsis is likely higher, as infections due to contaminated blood products are under-reported.2
Platelets are the most common source of transfusion-associated sepsis because platelets must be stored at room temperature which allows bacterial proliferation and, platelets are often given to neutropenic patients with impaired immune system function.1
Common nursing transfusion practice today is to infuse platelet products within an hour from start time. There is no scientific evidence supporting this practice. Nurses have long been advised by Laboratorians and blood bankers to transfuse platelets “as rapidly as tolerated” by the patient. Busy nurses have interpreted this instruction to mean that the product should be infused rapidly for the benefit of the patient when in reality the laboratory professionals are advising nurses to use their critical thinking skills to determine a safe, patient specific infusion rate when the physician has not ordered an infusion rate.
By simply slowing down the infusion rate during the first 15 minutes of platelet transfusion for non-hemorrhaging patients, nurses can improve patient safety and reduce the incidence and severity of transfusion-associated sepsis. The same nursing intervention that allows nurses to immediately recognize a severe allergic or hemolytic transfusion reaction during the first 15 minutes of a pRBC transfusion should be employed with platelet transfusions. This slow rate of infusion will expose the patient to the least amount possible of a potentially contaminated product and continuous nursing assessment during the first 15 minutes allows the nurse to immediately stop the transfusion at the first sign of an adverse response to the product.
Appropriate critical nursing analysis of platelet transfusion would have the nurse recognize the risk of transfusion-associated sepsis and start platelet transfusions at a rate of 60 – 100 mL/hour for the first 15 minutes.3 After confirming that there has been no change in the patient’s clinical status by repeating the nursing assessment, the transfusion rate may be increased up to 300 mL/hour depending upon the patient’s ability to tolerate the volume.
The risk of transfusion-associated sepsis supports a cautious and deliberate approach to platelet transfusion. Nurses can reduce the risk of life threatening sepsis by slowly infusing platelets during the first 15 minutes and immediately stopping the infusion at the first sign of clinical comprise thus reducing the amount of potentially contaminated product exposure. Rather than infusing platelets as rapidly as the patient tolerates, transfuse all blood products as slowly as medically necessary.
- Vamvakas EC. Blood still kills. Trans Med Rev 2010;24(2):77-124.
- AABB Technical Manual, 17th edition, Roback, J. et al: Bethesda, MD. 2011