Evaluating Coagulation Factors And Bacterial Contamination In Different Types Of Plasma Preparations At Kisii Teaching And Referral Hospital

Abstract

Blood transfusion components including packed red blood cell, cryoprecipitate, platelet concentrate as well as fresh frozen plasma (FFP) obtained from donation of whole blood or by apheresis collection are essentially used for life-saving and therapeutic for patients with a variety of health conditions. Patients with generalized blood loss (bleeding), reduced hematopoiesis or increased peripheral destruction of cells are managed by blood component therapy. Although mostly safe, blood transfusions to patients are associated with some risks including but not limited to bacterial contamination which contributes to morbidity and mortality among recipients. In Kenya, plasma obtained from donated units, eight hours post collection is often discarded without any consideration of coagulation factor levels. The study had an objective of evaluating coagulation factors and bacterial contamination in different plasma preparations at KTRH. This study employed mixed study design with interrupted time-series study design used to determine coagulation factor changes in FFP and cryoprecipitate for a period of five weeks with an interval of one week and cross-sectional study design to evaluate bacterial contamination in blood. Ethical clearance was acquired from Baraton University Ethic Committee. Blood collected from the Kisii satellite blood transfusion center was received at Hematology laboratory and microbiology laboratory where factor assays was performed on Erba Mannheim ECL 105 semi-automated coagulation analyzer from India. Testing for bacterial contamination was done by the use of BD BACTEC™ Automated Blood Culture machine at KTRH microbiology section to detect presence of gram positive or gram-negative bacteria. Further microbiological test to identify and confirm the bacteria by genus and species was done using culture technique and API-20. Quality controls procedures were performed in Hematology and Medical Microbiology laboratory at KTRH. Collected data was fed into Excel and thereafter analyzed by SPSS version 25. Analysis of bacterial contamination data was done by frequency distribution. Establishing the deterioration of coagulation factor levels in FFP and cryoprecipitate plasma during storage at -18°C for a period of five (5) weeks was done by Friedman’s ANOVA test for independence. Association between gender and bacterial contamination in the blood donated, blood group and coagulation factors in FFP and cryoprecipitate plasma was done by Pearson chi-square test. The study results showed that 23 (21.30%) of the blood donated was infected with bacteria. The prevalence rate for specific bacteria were high in Staphylococcus epidermidis with (39.39%), Staphylococcus aureus bacterium with (27.27%), Bacillus spp. and Escherichia coli (E coli) had 21.21% and 12.12% respectively. The Friedman’s ANOVA test showed that coagulation factors for both FFP and cryoprecipitate plasma were significantly reducing as from week one to week five of the study with p-value of 0.0001* < 0.05. Chi-square test indicated no statistical significant association existing between gender and bacterial infection and blood group and coagulation factors in FFP and cryoprecipitate with p-values of (0.333, 0.34 5 and 0.940) > 0.05. The study concluded that small proportion of the donated blood were contaminated by the bacteria and the coagulation factors were reducing significantly as from week one to week five for both FFP and cryoprecipitate. The study recommends that; venipuncture site should be thoroughly cleaned/disinfected before needle puncture during donation, donated blood should be screened of bacterial contamination just like the screening of the viral infections before being administered to the patient and blood bank should be alerted early enough when a patient is in need of fresh frozen plasma or cryoprecipitate for timely preparation. This will ensure that patient get all the rich available factors without any decline in level as a result of long storage.