2026 FSA Podium and Poster Abstracts

Background: Transfusion-transmitted bacterial infection is an uncommon but serious complication of blood component administration, particularly involving platelets stored at room temperature. Gram-negative organisms such as Klebsiella pneumoniae can proliferate rapidly in platelet units and cause fulminant sepsis. During anesthesia, early indicators of infection may be masked, and isolated changes in vital signs can mimic allergic or hemodynamic events. This report describes an intraoperative presentation of transfusion-transmitted sepsis in which the initial findings were subtle and nonspecific, highlighting the diagnostic challenge for anesthesiologists and the importance of maintaining vigilance during blood component administration.

Case Description: A 57yo male with alcohol-associated cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure under general anesthesia at Jackson Memorial Hospital (JMH). Preoperative thrombocytopenia prompted transfusion of a single-donor apheresis platelet unit. Approximately fifteen minutes after transfusion initiation, the patient developed tachycardia and oxygen desaturation to 80% without fever or hypotension. The anesthetic team managed the event as a possible allergic transfusion reaction while maintaining hemodynamic stability. A multidisciplinary evaluation was subsequently performed by anesthesiology, transfusion medicine, and the regional blood supplier. Clinical documentation, intraoperative events, transfusion records, and laboratory results were reviewed. A trace-back investigation was initiated to identify whether other recipients of components from the same donor had developed related infections. Molecular typing was used to determine strain identity among positive cultures.

Figure 1. Summarized timeline of case presentation

Discussion: Within hours, the patient developed worsening coagulopathy (INR >15; aPTT >200 s; fibrinogen <35 mg/dL), rising lactate, and progressive hemodynamic instability requiring vasopressors, mechanical ventilation, and renal replacement therapy. Blood cultures grew Klebsiella pneumoniae, whereas bronchoalveolar lavage cultures were negative. Despite broad-spectrum antimicrobial therapy and supportive measures, the patient developed multiorgan failure and died three days postoperatively. The platelet unit had been discarded after transfusion; however, the plasma co-component from the same apheresis donation was cultured and found sterile. A second patient who had received platelets from the same donor developed sepsis with an identical bacterial strain confirmed by molecular typing, establishing transfusion transmission. Preventive measures at JMH include thorough donor screening, skin disinfection before collection, diversion of the first collection sample, bacterial testing of platelet units, pathogen inactivation technologies, inspection of storage containers, and structured post-transfusion hemovigilance. Transfusion appropriateness is verified according to institutional policy before release.

Conclusion: This case demonstrates that transfusion-transmitted sepsis may initially present with subtle intraoperative findings that resemble allergic reactions, particularly when classic markers such as fever or hypotension are absent. For anesthesiologists, the temporal association between transfusion and unexplained physiologic instability should prompt consideration of septic transfusion reactions. The coordinated response between the clinical team, transfusion service, and blood supplier enabled rapid identification of a linked infection in another recipient, illustrating the value of hemovigilance systems. Although modern safety measures substantially reduce risk, rare contamination events may still occur. Maintaining diagnostic awareness, communicating early with transfusion services, and adhering to institutional transfusion practices remain essential for enhancing perioperative patient safety.