Knowledge, attitude and practice survey of bacterial contamination of blood for transfusion in the Democratic Republic of the Congo.

BACKGROUND: We assessed healthcare worker's knowledge-attitude-practice regarding bacterial contamination of blood products in the Democratic Republic of the Congo. MATERIALS AND METHODS: In three hospitals and the National Blood Transfusion Centre (NBTC), two multiple-choice surveys were completed on a tablet computer: one each, for blood bank (31 questions) and for clinical ward staff (20 questions). A score was calculated for 11 overlapping knowledge questions. RESULTS: Among 247 participants (blood bank No.=62, ward No.=185), median (range) knowledge score was 10 (2-19) on a maximum of 20, with blood bank staff (12/20) scoring higher than clinical ward staff (9/20) (p<0.0001). Half (50.2%) of 247 participants recalled previous training in transfusion medicine. Participants had limited understanding of and compliance with NBTC-recommended preventive measures: incorrect assumption that wearing gloves prevents bacterial contamination (83.8%) and that blood banks test donor blood for bacteria (59.9%). Half (50.0%) of blood bank staff did not acknowledge the NBTC-recommended antisepsis procedure, 62.1% did not apply the appropriate number of antisepsis steps, and 32.3% saw no harm in touching the venipuncture site after antisepsis. Presence of bacteria on healthy skin (62.3%) and blood bank fomites (examination gloves: 30.8%, soap: 62.8%) was underestimated. Although 92.4% of clinical ward staff said to easily recognize transfusion reactions, only 15.7% recognized septic reactions and post-transfusion antibiotic treatment practices were not consistent. Challenges reported by blood bank staff and particular for low-resource settings were: frequent power cuts (98.4%), transport of blood products by patient attendants (41.1%), without cooling elements (64.4%), and reuse of finished antiseptic/disinfectant containers (75.4%). DISCUSSION: The present study points to gaps in knowledge, attitudes, practices along sampling, cold chain and transfusion which can feed customized training and monitoring.

Observational study of corrected count increments after transfusion of platelets treated with riboflavin pathogen reduction technology in additive solutions.

BACKGROUND: Mirasol pathogen reduction technology (PRT) treatment inactivates bacteria, viruses, and parasites in plasma products and platelets (PLTs) suspended in plasma and PLT additive solutions (PAS). Few clinical studies exist documenting transfusions with PAS. This study objective was to evaluate the count increments of PRT-treated PAS-C and PAS-E buffy coat (BC) PLTs in routine use observational settings. STUDY DESIGN AND METHODS: PLT pools of five or six BCs were collected, processed, and suspended in PAS-C or PAS-E, respectively. Products were exposed to ultraviolet light in the presence of riboflavin and then transfused into 19 patients with hematologic diseases. Patients were monitored for PLT corrected count increment (CCI) at 1 and 24 hours and for any adverse events in the 72 hours after transfusion. Sterility monitoring was performed with a microbial detection system (BacT/ALERT, bioMérieux). RESULTS: The PAS-E products had significantly higher PLT concentrations and counts than the PAS-C products. The mean CCIs of per-protocol (PP) units at 1 and 24 hours were 11,900 (n=27) and 5500 (n=30), respectively. Seventy-eight percent of PP transfusions classify as successful with CCIs at 1 hour of higher than 7500, and 63% higher than 4500 at 24 hours. One patient was excluded from all analyses as she was refractory to Mirasol-treated PLT transfusions and follow-up untreated transfusion products. No adverse events were observed and no contaminated products were detected by BacT/ALERT. CONCLUSION: PRT-treated BC PLTs in PAS-C or PAS-E demonstrate PLT transfusion success rates in hematology patients with thrombocytopenia that are comparable to previous studies examining PLTs stored in plasma.

Paired analysis of plasma proteins and coagulant capacity after treatment with three methods of pathogen reduction.

BACKGROUND: The effect of photochemical pathogen reduction (PR) methods on plasma quality has been the subject of several reports but solid comparative data for the different technologies are lacking. STUDY DESIGN AND METHODS: Plasma (n = 24) photoinactivated with methylene blue (MB), riboflavin (RF), or amotosalen (AS) was compared using a pool-and-split design. Samples were taken before and after treatment with each method and tested for coagulation factors (fibrinogen, Factor [F] II, FV, FVIII, F IX, FXI), natural coagulation inhibitors (Protein C [PC], protein S [PS], antithrombin III [AT]), prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin generation (TG). The three methods were mutually compared by repeated-measures analysis of variance. RESULTS: All three PR methods cause significant reduction (p < 0.01) of activity of the procoagulant proteins fibrinogen, FII, FV, FVIII, F IX, and FXI. Coagulation is also affected, with significant changes in PT, APTT, and TG. RF treatment causes a significantly higher decrease in concentration of coagulation factors, PS, and AT than the other methods (p < 0.01). PT, APTT, and TG are also affected most by RF treatment. FII, FVIII, F IX, PC, AT, and PT are best preserved with the MB method and FV, FXI, and TG after AS treatment (p < 0.01). Coagulation factor loss due to the volume loss during PR treatment is more important for MB and AS than for RF. CONCLUSION: PR treatment of plasma affects coagulation proteins and coagulant capacity. For the RF method this effect is most pronounced, although to some extent compensated by a smaller volume loss.