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Post-Partum Transfusion Related Blood Stream Infection and Septic Shock
Abstract Number: T-73
Abstract Type: Case Report/Case Series
In recent years the precautions that protect patients against infected blood products has improved drastically. In addition the thresholds for transfusing have been modified to err on the side of caution, and therefore transfuse less product. Furthermore, bacteria are very rarely transmitted during blood component transfusion, but if they are, they usually cause severe, life-threatening adverse reactions, with the mortality rate of 20 – 30%. Bacteria transmission during transfusion is the second (just after “administrative error”) most common cause of fatal transfusion-associated reactions.
We present a case of a 30-year-old G3P4 female patient who developed rapid, life-threatening septic shock with disseminated intravascular coagulation (DIC) and multiple organ failure after receiving a blood transfusion.
The patient had undergone an uneventful cesarean section for twins. On post-operative day 2 she received two units of packed red blood cells for a hemoglobin of 6.7. The first unit transfused uneventfully. Shortly after the second unit was started, the patient presented with sudden chills, muscle pain and cramping in the low back and bilateral legs, fever, hypertension, and tachycardia. Blood cultures from the patient initially showed the presence of gram-negative rods, which, later were revealed to be Pseudomonas fluorescens. Cultures from the second unit of blood confirmed that it was contaminated with the same gram-negative bacterium, Pseudomonas fluorescens.
The patient had a complicated hospital course including septic shock with multi-organ failure requiring dialysis, mechanical ventilation for respiratory failure, and multiple operations due to intraabdominal hemorrhage. This case demonstrates a rare complication of a transfusion reaction as well as the management of of sepsis in a post-partum patient.