Update on ISBT Interna/onal Survey on Transfusion- transmi9ed Bacterial Infec/ons
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1 Update on ISBT Interna/onal Survey on Transfusion- transmi9ed Bacterial Infec/ons Edward Chew & Erica Wood On behalf of the WPs on TTID and HV Rationale & construction of survey Demographics of respondents Blood supplier(s) Haemovigilance programmes Transfusion-transmitted bacterial infection (TTBI) Bacterial contamination of blood components
2 Variability in defini/ons of TTBI Variability in approach to: Ini/al inves/ga/ons Confirmatory tes/ng Repor/ng of events Preven/ve measures Joint initiative of: Haemovigilance WP TTID WP Assessment of definitions and current practices in prevention, diagnosis, management and reporting Initial draft questionnaire with feedback from WP members Wide distribution of final questionnaire First survey results reported to WP at ISBT Congress in June 03 Additional contacts ed December 03
3 Rationale & construction of survey Demographics of respondents Blood supplier(s) Haemovigilance programme Transfusion-transmitted bacterial infection (TTBI) Bacterial contamination of blood components Future directions Demographics of respondents par/cipants in 73 countries invited to par/cipate 58 responses from 39 countries Good representa/on of countries & organisa/ons Some responses joint submissions from members of the same organisa/on 3
4 Demographics of respondents 39 countries Demographics of respondents 58 respondents 5 medical 7 non- medical 7 countries had more than blood supplier 4
5 Rationale & construction of survey Demographics of respondents Blood supplier(s) Haemovigilance programme Transfusion-transmitted bacterial infection (TTBI) Bacterial contamination of blood components Future directions Haemovigilance Programmes Haemovigilance Programmes according to Regional/Na9onal and Voluntary/Mandatory No Haemovigilance Programme Regional Haemovigilance Programme Voluntary Na/onal & Regional Haemovigilance Programme 3 Mandatory Na/onal Haemovigilance Programme Number of Countries 5
6 TTBI defini/ons Standard definition of TTBI available for: 7/58 respondents from 7 countries Australia Belgium Brazil Canada Finland Germany Japan Jordan Morocco Netherlands (TRIP) New Zealand Portugal Republic of Korea South Africa Switzerland UK (SHOT) USA (CDC) CCDR Canada Communicable Disease Report ISSN Rationale & construction of survey Demographics of respondents Blood supplier(s) Haemovigilance programme Transfusion-transmitted bacterial infection (TTBI) Bacterial contamination of blood components Future directions 6
7 Transfusion- transmi9ed Bacterial Infec/ons What clinical symptoms and signs might suggest or be consistent with a potential case of TTBI? TTBI symptoms Symptoms and signs consistent with a TTBI Fever 48 0 Rigors Hypotension Hypertension Tachycardia 4 4 Symptoms and signs Bradycardia Shortness of breath Hypoxia Agita/on and/or confusion Lumbar/back pain Yes No Maybe Not answered Pain at infusion site Others 0 36 No symptoms Number of responses 7
8 TTBI: Other symptoms / signs: Nausea, vomiting Abdominal pain Diarrhoea Oliguria, renal failure Headache, encephalitis, meningitis Jaundice Myalgia, arthralgia Cyanosis Shock Chest pain DIC Death What tests are required / performed to investigate a suspected clinical case of TTBI? 8
9 Tests performed for inves9ga9on of a poten9al TTBI Culture of implicated component 48 9 Culture of any associated blood component prepared from 44 3 Blood culture of the recipient 44 3 Gram stain of implicated component 34 Blood group & an/body screen of recipient Tests Full blood count of the recipient Yes Haemolysis screen of the recipient No Chest X- ray of the recipient 9 7 Not answered Urine culture of the recipient Molecular test (eg pulsed- field gel electrophoresis) 5 Other Number of responses 5 / 37 do not routinely perform molecular tests Other tests performed: Visual inspection (haemolysis) CRP Antibiotic testing Serotyping Pulsed-field electrophoresis Sequence comparisons of isolates Verax PGD testing Exclude other transfusion reactions Imputability for TTBI assigned: Locally (0 / 46 respondents) HVP (9 / 46 respondents) Joint hospital and HVP (3 / 46 respondents) Other () Not specified () 9
10 For the purpose of reporting to HV Programmes: 3 / 40 respondents differentiate between suspected and confirmed cases 30 / 3 report suspected but not confirmed cases to their HV Programmes 38 / 40 respondents report confirmed cases to their HV Programmes Rationale & construction of survey Demographics of respondents Blood supplier(s) Haemovigilance programme Transfusion-transmitted bacterial infection (TTBI) Bacterial contamination of blood components Future directions 0
11 Bacterial Contamina/on of Blood Components What measures are in place at the time of blood collection / preparation to reduce the risk of TTBI? Measures at the Time of Blood Collec9on / Prepara9on to Reduce Risk of TTBI Donor Ques/onnaire 50 Donor Health Assessment 43 6 Yes Skin Prepara/on 50 No Diversion Pouch
12 Other measures to reduce bacterial contamination: CRP of donors Pathogen reduction technology Short expiry Visual inspection Bacterial surveillance of PC / outdated PC Random culture of blood products Rou9ne Screening for Bacterial Contamina9on of Blood Components with a Sample Taken for Tes9ng Prior to Release Not known 3 No 0 Yes 5 3 Blood Supplier Both
13 Summary Summary International survey providing a snapshot of practices around the world Variation in TTBI definitions used Variation in practices for prevention, management and investigation of TTBI Summary of different definitions Basis for possible standardised definition in the future 3
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Information for professionals for Cytotect CP Biotest: Biotest (Switzerland) AG Complete information for professionals DDD Print
Information for professionals for Cytotect CP Biotest: Biotest (Switzerland) AG Complete information for professionals DDD Print Composition 1 ml solution contains: Active ingredients:. plasma proteins