From: Medscape Today
Medscape Today- Medscape

Cases from AHRQ WebM&M: What Was in Those Platelets?

Roslyn A Yomtovian, MD

The Case
A 47-year-old woman was admitted to the hospital for complex spinal surgery. The surgery went well without complications, and postoperatively she was transferred to a general surgical ward. Shortly thereafter, she spiked a fever, became tachycardic, hypotensive, and hypoxic, and developed a red rash across her chest. She was reintubated (placed back on the mechanical ventilator), given an infusion of dopamine to maintain adequate blood pressure, and transferred to the intensive care unit (ICU). She was found to have severe septic shock and developed multiorgan system failure. On initial evaluation, the clinicians were puzzled and confused because there was no clear cause for her septic shock.

On the same day, a 76-year-old man with coronary artery disease and a prosthetic aortic valve was admitted for spinal surgery. The procedure went well, and he was stable and transferred to a general surgical ward postoperatively. Later that evening, he developed tachycardia, hypotension, and hypoxia, requiring reintubation and transfer to the ICU. He was found to have sepsis and, despite extensive diagnostic testing, the clinical team could not identify a clear cause for his decompensation.

Given the similarity in clinical course, the hospital investigated the two cases. Upon detailed review, the blood bank discovered that both patients had received intraoperative platelet transfusions from the same batch of platelets. With further testing, it was determined that the entire batch of platelets was contaminated with Staphylococcus aureus, a virulent and aggressive bacteria often found in hospitals.

The 47-year-old woman remained critically ill for many days and had Staphylococcus aureus in her bloodstream for more than a week despite antibiotic therapy. She had a long and complicated hospitalization, but she was ultimately discharged in stable condition. The bacterium was never cultured from the blood of the 76-year-old man, but he remained febrile in the ICU for many days. Given his prosthetic valve, an echocardiogram was obtained that showed possible bacterial endocarditis (infection of his heart valve with the bacteria). In addition to a prolonged hospitalization, he required 6 weeks of intravenous antibiotics as a result of the contaminated platelet transfusion. . .

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