Non bacterial infection

It is important hospitals report when a patient has a (non bacterial) infection post-transfusion as soon as possible to ensure a thorough investigation

Investigations

NHSBT clinicians from Microbiology Services lead the investigations.

Advice

We are happy to discuss / give advice about a case before a formal report is considered; please the contact information and a discussion with our clinical team can be arranged.

Consultation

When a report is received the team consult with a multi-disciplinary team, after which further information and/or test results may be requested.

What to include in a report 

1. Hospitals email a completed post transfusion infection report form (nhsbt.transfusionmicrobiology@nhs.net) including: 

- the patient's name, date of birth and NHS number

- the hospital of transfusion 

- documented evidence of infection (i.e. copies of laboratory reports)

- the infection status of the patient, either prior to or at the time of the transfusion (not usually available, but very useful)

- a list of all units used with the unit number/s, component type/s, date of transfusion and the patient identity, preferably as a typed print-out to avoid the risk of transcription errors and to assist the audit trails

 - details of the patient's medical history, previous medical / surgical procedures, and any other risk for the identified infection. 

(please note: only include personal identifiable details if you are sending from a secure NHS.net account).

What happens then

1. The team start the investigation by:

- matching the unit numbers to corresponding donors

- checking the donor's record for evidence of subsequent donations; reviewing the results of tests on later donations 

- checking the results of subsequent tests, to determine whether they can be used to exclude the donor as a source of infection

- recalling all other donors for specific testing for the marker in question.

2  Archive material for genome amplification may be selected and if necessary genotyped to match source and recipient.

3. Where the donor has re-attended and routine donation screening includes antibody assays, a subsequent negative test result will usually be sufficient to eliminate the donor as a source of infection. In other cases, including all involving hepatitis B infection, additional tests will be needed and follow-up blood samples may be required from the donor. It may take some weeks or months to complete the investigation.

4 In certain circumstances, NHSBT may be requested to investigate possible transmission of an infection for which routine blood donation screening is not in place (e.g. parvovirus B19 infection) or for which selective donation screening is carried out (CMV infection, malaria). Such cases usually require detailed discussions between clinicians and testing laboratories.

5. The team send the final report to the consultant haematologist, in charge of the blood transfusion laboratory which supplied the blood to the patient, the reporter, and any other interested party.

6. Microbiology Services report the incident to SHOT.

7. Hospitals report to the MHRA and to the local hospital Infection Prevention and Control team so that other possible sources of infection in the hospital can be investigated. 

8. Additional investigation may involve the local Health Protection team or specialist laboratories at the UK Health Security Agency (UKHSA). NHSBT liaise with other teams within the hospital and UKHSA as appropriate.

9. At the close of the investigation a formal report is sent to the consultant haematologist in charge of the blood transfusion laboratory which supplied the blood to the patient, the reporter, and any other interested party. All cases are reported through the NHSBT / UKHSA Epidemiology team to SHOT.

Contact

Telephone: 0208 957 2988
Secure fax: 0208 957 2884
Email: nhsbt.transfusionmicrobiology@nhs.net

Microbiology Services
NHSBT Colindale
6 Lingard Avenue
Colindale
London
NW9 5BG