title: Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions.
abstract: Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PTs) in sub-Saharan Africa (SSA).
  
  
  
  This prospective, observational study evaluated the rate of BC in whole blood-derived platelet units (WB-PUs), the utility of performing Gram stains to prevent septic reactions, characteristics of patients receiving PTs, and the rate of acute reactions associated with PTs at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform Gram stains and culture using the Bactec 9120 instrument. Study participants were monitored for reactions.
  
  
  
  In total, 337 WB-PUs were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3% to 2.1% (according to criteria used to define BC). The Gram stain had high specificity (99.1%) but low sensitivity to detect units with BC. The median platelet count before PT was 10,900 cells/µL (interquartile range, 6000-18,900 cells/µL). Overall, 78% of PTs were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PUs, for a rate of 7.3% (95% confidence interval, 3.7%-12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction.
  
  
  
  The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. Because Gram staining appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially contaminated platelets in sub-Saharan Africa.
authors.affiliation: Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montreal, Québec, Canada.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Hume
authors.affiliation: Uganda Cancer Institute.
authors.forename: Henry
authors.initials: H
authors.lastname: Ddungu
authors.affiliation: Uganda Cancer Institute.
authors.forename: Racheal
authors.initials: R
authors.lastname: Angom
authors.affiliation: College of Health Sciences, Makerere University.
authors.forename: Hannington
authors.initials: H
authors.lastname: Baluku
authors.affiliation: College of Health Sciences, Makerere University.
authors.forename: Henry
authors.initials: H
authors.lastname: Kajumbula
authors.affiliation: Uganda Blood Transfusion Service, Kampala, Uganda.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Kyeyune-Byabazaire
authors.affiliation: Uganda Cancer Institute.
authors.forename: Jackson
authors.initials: J
authors.lastname: Orem
authors.affiliation: Canadian Blood Services, Ottawa, Ontario, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ramirez-Arcos
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D001424:Bacterial Infections / Q000209:etiology*; D001792:Blood Platelets / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D017713:Platelet Transfusion / Q000009:adverse effects*; D011446:Prospective Studies; D065227:Transfusion Reaction / Q000209:etiology*; D055815:Young Adult