Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Transfusion-transmitted bacterial infection

Denis Spelman, MBBS, FRACP, FRCPA, MPH
Section Editor
Anthony Harris, MD, MPH
Deputy Editor
Elinor L Baron, MD, DTMH


Transfusion-transmitted bacterial infection (TTBI) is an important complication of blood product administration [1-3]. The incidence of TTBI is higher than the incidence of transfusion-transmitted viral infection [4-6].

Issues related to TTBI will be reviewed here. Issues related to laboratory testing of donated blood for infectious agents are discussed separately. (See "Blood donor screening: Laboratory testing".)


There is no consensus definition for transfusion-transmitted bacterial infection [1-3]:

One paper published by a French group separated reports into definite, probable, and possible cases [1]. In "definite" cases, the same bacteria were isolated from both the blood product and the transfusion recipient. In "probable" cases, bacteria were isolated from the blood product, but the recipient's blood was either not cultured or was culture negative. In "possible" cases, no bacteria were isolated from the blood product (either because culture was not performed or was negative) and the blood culture from the recipient was positive with no other apparent source.

A British group defined transfusion-transmitted bacterial infection as bacterial infection following transfusion (in the absence of infection prior to transfusion), with evidence of blood product contamination or infection in the donor [2].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 14, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Perez P, Salmi LR, Folléa G, et al. Determinants of transfusion-associated bacterial contamination: results of the French BACTHEM Case-Control Study. Transfusion 2001; 41:862.
  2. Williamson LM, Lowe S, Love EM, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ 1999; 319:16.
  3. Kuehnert MJ, Roth VR, Haley NR, et al. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion 2001; 41:1493.
  4. Vasconcelos E, Seghatchian J. Bacterial contamination in blood components and preventative strategies: an overview. Transfus Apher Sci 2004; 31:155.
  5. Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future. Lancet 2003; 361:161.
  6. Jacobs MR, Palavecino E, Yomtovian R. Don't bug me: the problem of bacterial contamination of blood components--challenges and solutions. Transfusion 2001; 41:1331.
  7. Brecher ME, Hay SN. Bacterial contamination of blood components. Clin Microbiol Rev 2005; 18:195.
  8. Wagner SJ. Transfusion-transmitted bacterial infection: risks, sources and interventions. Vox Sang 2004; 86:157.
  9. Morduchowicz G, Pitlik SD, Huminer D, et al. Transfusion reactions due to bacterial contamination of blood and blood products. Rev Infect Dis 1991; 13:307.
  10. Bryant BJ, Conry-Cantilena C, Ahlgren A, et al. Pasteurella multocida bacteremia in asymptomatic plateletpheresis donors: a tale of two cats. Transfusion 2007; 47:1984.
  11. Sugai Y, Sugai K, Fuse A. Current status of bacterial contamination of autologous blood for transfusion. Transfus Apher Sci 2001; 24:255.
  12. Casewell MW, Slater NG, Cooper JE. Operating theatre water-baths as a cause of pseudomonas septicaemia. J Hosp Infect 1981; 2:237.
  13. Arduino MJ, Bland LA, Tipple MA, et al. Growth and endotoxin production of Yersinia enterocolitica and Enterobacter agglomerans in packed erythrocytes. J Clin Microbiol 1989; 27:1483.
  14. Roth VR, Arduino MJ, Nobiletti J, et al. Transfusion-related sepsis due to Serratia liquefaciens in the United States. Transfusion 2000; 40:931.
  15. Leiby DA, Gill JE. Transfusion-transmitted tick-borne infections: a cornucopia of threats. Transfus Med Rev 2004; 18:293.
  16. Wells GM, Woodward TE, Fiset P, Hornick RB. Rocky mountain spotted fever caused by blood transfusion. JAMA 1978; 239:2763.
  17. Cable RG, Leiby DA. Risk and prevention of transfusion-transmitted babesiosis and other tick-borne diseases. Curr Opin Hematol 2003; 10:405.
  18. Herwaldt BL, Neitzel DF, Gorlin JB, et al. Transmission of Babesia microti in Minnesota through four blood donations from the same donor over a 6-month period. Transfusion 2002; 42:1154.
  19. Hanron AE, Billman ZP, Seilie AM, et al. Detection of Babesia microti parasites by highly sensitive 18S rRNA reverse transcription PCR. Diagn Microbiol Infect Dis 2017; 87:226.
  20. Blajchman MA, Goldman M. Bacterial contamination of platelet concentrates: incidence, significance, and prevention. Semin Hematol 2001; 38:20.
  21. Chiu EK, Yuen KY, Lie AK, et al. A prospective study of symptomatic bacteremia following platelet transfusion and of its management. Transfusion 1994; 34:950.
  22. Kleinman SH, Kamel HT, Harpool DR, et al. Two-year experience with aerobic culturing of apheresis and whole blood-derived platelets. Transfusion 2006; 46:1787.
  23. Kleinman S, Reed W, Stassinopoulos A. A patient-oriented risk-benefit analysis of pathogen-inactivated blood components: application to apheresis platelets in the United States. Transfusion 2013; 53:1603.
  24. Kunishima S, Inoue C, Kamiya T, Ozawa K. Presence of Propionibacterium acnes in blood components. Transfusion 2001; 41:1126.
  25. Soeterboek AM, Welle FH, Marcelis JH, van der Loop CM. Sterility testing of blood products in 1994/1995 by three cooperating blood banks in The Netherlands. Vox Sang 1997; 72:61.
  26. Liumbruno GM, Catalano L, Piccinini V, et al. Reduction of the risk of bacterial contamination of blood components through diversion of the first part of the donation of blood and blood components. Blood Transfus 2009; 7:86.
  27. Yomtovian R, Lazarus HM, Goodnough LT, et al. A prospective microbiologic surveillance program to detect and prevent the transfusion of bacterially contaminated platelets. Transfusion 1993; 33:902.
  28. Kreuger AL, Middelburg RA, Kerkhoffs JH, et al. Storage medium of platelet transfusions and the risk of transfusion-transmitted bacterial infections. Transfusion 2017; 57:657.
  29. Dellinger EP, Anaya DA. Infectious and immunologic consequences of blood transfusion. Crit Care 2004; 8 Suppl 2:S18.
  30. Transfusion Transmitted Injuries Section, Blood Safety Surveillance and Health Care Acquired Infections Division, Public Health Agency of Canada. Guideline for investigation of suspected transfusion transmitted bacterial contamination. Can Commun Dis Rep 2008; 34 Suppl 1:1.
  31. Seidl S, Kühnl P. Transmission of diseases by blood transfusion. World J Surg 1987; 11:30.
  32. de Korte D, Curvers J, de Kort WL, et al. Effects of skin disinfection method, deviation bag, and bacterial screening on clinical safety of platelet transfusions in the Netherlands. Transfusion 2006; 46:476.
  33. Eder AF, Kennedy JM, Dy BA, et al. Limiting and detecting bacterial contamination of apheresis platelets: inlet-line diversion and increased culture volume improve component safety. Transfusion 2009; 49:1554.
  34. WHO guidelines on drawing blood: best practices in phlebotomy http://whqlibdoc.who.int/publications/2010/9789241599221_eng.pdf (Accessed on September 29, 2011).
  35. Wollowitz S. Fundamentals of the psoralen-based Helinx technology for inactivation of infectious pathogens and leukocytes in platelets and plasma. Semin Hematol 2001; 38:4.
  36. Information for AABB members www.aabb.org (Accessed on October 10, 2011).
  37. Commission on Laboratory Accreditation. Laboratory Accreditation Program transfusion medicine checklist: September 2007 http://www.cap.org/apps/docs/laboratory_accreditation/checklists/transfusion_medicine_sep07.pdf (Accessed on October 11, 2011).
  38. Brecher ME, Hay SN, Rothenberg SJ. Validation of BacT/ALERT plastic culture bottles for use in testing of whole-blood-derived leukoreduced platelet-rich-plasma-derived platelets. Transfusion 2004; 44:1174.
  39. Yazer MH, Triulzi DJ. Use of a pH meter for bacterial screening of whole blood platelets. Transfusion 2005; 45:1133.
  40. Fang CT, Chambers LA, Kennedy J, et al. Detection of bacterial contamination in apheresis platelet products: American Red Cross experience, 2004. Transfusion 2005; 45:1845.
  41. Wagner SJ, Robinette D. Evaluation of swirling, pH, and glucose tests for the detection of bacterial contamination in platelet concentrates. Transfusion 1996; 36:989.
  42. Werch JB, Mhawech P, Stager CE, et al. Detecting bacteria in platelet concentrates by use of reagent strips. Transfusion 2002; 42:1027.
  43. Schmidt M, Hourfar MK, Nicol SB, et al. FACS technology used in a new rapid bacterial detection method. Transfus Med 2006; 16:355.
  44. Jacobs MR, Smith D, Heaton WA, et al. Detection of bacterial contamination in prestorage culture-negative apheresis platelets on day of issue with the Pan Genera Detection test. Transfusion 2011; 51:2573.
  45. Burstain JM, Brecher ME, Workman K, et al. Rapid identification of bacterially contaminated platelets using reagent strips: glucose and pH analysis as markers of bacterial metabolism. Transfusion 1997; 37:255.
  46. Centers for Disease Control and Prevention (CDC). Fatal bacterial infections associated with platelet transfusions--United States, 2004. MMWR Morb Mortal Wkly Rep 2005; 54:168.
  47. Sen K. Rapid identification of Yersinia enterocolitica in blood by the 5' nuclease PCR assay. J Clin Microbiol 2000; 38:1953.
  48. Ribault S, Harper K, Grave L, et al. Rapid screening method for detection of bacteria in platelet concentrates. J Clin Microbiol 2004; 42:1903.
  49. Harm SK, Delaney M, Charapata M, et al. Routine use of a rapid test to detect bacteria at the time of issue for nonleukoreduced, whole blood-derived platelets. Transfusion 2013; 53:843.
  50. Zhao Z, Chalmers A, Rieder R. Rapid detection of contaminant bacteria in platelet concentrate using differential impedance. Vox Sang 2014; 107:114.
  51. Zweitzig DR, Riccardello NM, Pester JM, et al. A novel approach for rapid detection of bacterially contaminated platelet concentrates via sensitive measurement of microbial DNA polymerase activity. Transfusion 2014; 54:1642.