Should blood be transfused in a patient with bacteremia?

From the Guidelines

Blood transfusion can be performed in patients with bacteremia, but it should be guided by a restrictive strategy, transfusing when the hemoglobin concentration decreases to <7.0 g/dL in adults, as recommended by the Surviving Sepsis Campaign guidelines 1. The primary focus should be on treating the underlying infection with appropriate antibiotics before or concurrent with the transfusion. Blood products should be administered when clinically indicated, such as when the patient has significant anemia, active bleeding, or symptoms of inadequate oxygen delivery. During transfusion, patients with bacteremia require close monitoring for signs of transfusion reactions or worsening sepsis, including fever spikes, hypotension, tachycardia, or respiratory distress. The decision to transfuse should be individualized based on the patient's clinical status, hemodynamic stability, source of infection, and response to antimicrobial therapy, as supported by guidelines from the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 1. Key considerations include:

• Transfusing red blood cells when hemoglobin concentration decreases to <7.0 g/dL in adults, as recommended by the guidelines 1.
• Avoiding the use of erythropoietin for treatment of anemia associated with sepsis, as it has not shown to improve clinical outcomes 1.
• Using fresh frozen plasma and platelets judiciously, based on the presence of bleeding or planned invasive procedures, and significant risk of bleeding, respectively 1. The most recent and highest quality study, the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 1, provides the basis for these recommendations, prioritizing morbidity, mortality, and quality of life as the primary outcomes.

From the Research

Bacteremia and Blood Transfusion

• The decision to transfuse blood to a patient with bacteremia should be made with caution, as transfusion of contaminated blood products can lead to sepsis, disseminated intravascular coagulation, and death 2.
• Bacterial contamination of blood components, especially platelets, is a significant risk, with an estimated prevalence of 1 in 2000-3000 whole-blood derived, random donor platelets, and apheresis-derived, single donor platelets 3.
• The risk of transfusion-associated sepsis due to contaminated platelet concentrates is much higher than that due to red cells, with an estimated prevalence of 1 in 50,000 per platelet unit and 1 in 500,000 per red cell unit transfused 4.

Strategies to Minimize Infection Risk

• Improved donor skin disinfection, removal of the first aliquot of donor blood, pre-transfusion detection of bacteria, reducing recipient exposure, and pathogen reduction/inactivation are strategies that can be employed to decrease the risk of transfusion-associated morbidity and mortality due to contaminated blood products 3.
• The use of blood donor history and state-of-the-art FDA-licensed serological and nucleic acid testing (NAT) assays can help reduce the risk of transfusion-transmitted pathogens, including bacterial contamination 5.
• Rapid quantitative immunoassays are available to test for the presence of lipotechoic acid and lipopolysaccharide bacterial products prior to platelet transfusion, which can help detect potential bacterially contaminated platelet products 5.

Considerations for Patients with Bacteremia

• The risk of transfusion-associated sepsis should be carefully weighed against the potential benefits of blood transfusion in patients with bacteremia 2.
• Patients with bacteremia may require repeated transfusions, which increases their exposure to the risk of transfusion-associated sepsis 6.
• The decision to transfuse blood to a patient with bacteremia should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical condition 3.