ABSTRACT
BACKGROUND: Pediatric hematology-oncology patients require frequent platelet transfusions to manage chemotherapy-induced thrombocytopenia, and allergic transfusion reactions (ATRs) are common. Risk for platelet-associated ATRs can result from recipient- or donor-specific factors. STUDY DESIGN AND METHODS: We report a rare case in which an individual platelet donor caused repeated ATRs in multiple recipients. This observation led us to conduct a retrospective study at a pediatric hematology-oncology center to identify donor- and recipient-associated risk factors for ATRs. RESULTS: Single-donor platelets from an individual donor precipitated ATRs in 78.6% (n = 11/14) of recipients and 66.7% (n = 12/18) of platelet transfusions. We found in a cohort of pediatric hematology-oncology patients that 12.6% of recipients and 1.0% of platelet transfusions were associated with ATRs. Recipients who were aged 4 to 18 years, male, and those with central nervous system or solid tumors and with a history of ATRs to platelets were more likely to experience ATRs. Donor-associated risk factors were not identified, and we did not implicate additional donors in our single-center cohort with a frequency of ATRs comparable to the index donor. Based on our findings, we developed a novel statistical model to identify recipients and donors prone to experiencing or mediating ATRs. CONCLUSIONS: Both donors and recipients contribute to ATRs. Identification of high-risk donors and recipients for further scrutiny and potential interventions can improve the safety of platelet transfusions.
Subject(s)
Hematologic Neoplasms/blood , Hematologic Neoplasms/immunology , Platelet Transfusion/adverse effects , Transfusion Reaction/etiology , Adolescent , Adult , Aged , Blood Donors , Central Nervous System Neoplasms/blood , Central Nervous System Neoplasms/immunology , Child , Child, Preschool , Cohort Studies , Female , Hospitals , Humans , Infant , Male , Middle Aged , Models, Statistical , Retrospective Studies , Risk Factors , Thrombocytopenia/complications , Young AdultABSTRACT
BACKGROUND: The optimal use of blood cultures to determine the etiology of febrile episodes in neutropenic children has not been well-defined. METHODS: Single volume blood cultures using the Pediatric ISOLATOR System (ISO), were compared with variable, weight-based culture volumes using the BACTEC 9240 Culture System (BAC). Additionally the value of routinely inoculating the BACTEC MYCO/F LYTIC culture vial (MFL) as well as the BACTEC AEROBIC/F culture vial (AF) was examined. RESULTS: A total of 2620 cultures had both ISO and BAC inoculated; 182 cultures were positive (7.0% of cultures); 97.8% of positive cultures were detected by the BAC (AF and/or MFL) vs.46.2% detected by the ISO. The advantage of the BAC over the ISO was statistically significant for overall recovery of isolates and bloodstream infections, including most individual organism categories. There were only two instances (one each of histoplasmosis and candidemia) in which a blood stream infection was detected by ISO only. All the isolates judged to be contaminants were recovered by BAC only. AF detected significantly more coagulase-negative Staphylococcus spp. than the MFL. Of the isolates 16%, representing 14% of the bloodstream infections (including Gram-negative infections), were detected by the MFL only. Infections were detected more quickly by BAC than by ISO (P < 0.0001). Among the BAC media types, AF was faster than MFL (P < 0.0001). CONCLUSIONS: Optimal yield of blood cultures in immunocompromised pediatric patients included the use of BAC with a weight-based, graduated volume of culture inoculation and routine use of both AF and MFL.
