Abdul Mannan: The ‘Dirty Blood’ Protocol – Early Recognition of Bacterial Contamination in Blood Transfusion Reactions
Abdul Mannan, Consultant Hematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
“Whatever you do, do not throw away that blood bag.
Your patient spikes to 40°C mid-transfusion.
Rigors shake them. Blood pressure crashes. This is warm shock. And the transfusion itself may be the cause.
Here is what is happening:
Bacteria gets into the bag. It comes from donor skin during collection or from silent bacteraemia in the donor.
And here is the thing most people do not think about: platelets are stored at room temperature, not refrigerated. That makes them the highest-risk product for bacterial growth.
This is what we call ‘Dirty Blood.’
What you do Right Now:
Stop the transfusion immediately
Take blood cultures from the patient
Return the blood pack for culture. Do Not discard it.
This is how you confirm the diagnosis.
Start broad-spectrum IV antibiotics immediately. Do not wait for culture results.
Resuscitate with IV fluids
BSH transfusion reaction guidance is clear: speed of antibiotic treatment directly affects survival.
Every minute of delay matters.
The mistake I see too often?
The bag gets thrown away before anyone thinks to send it for culture. No bag, no diagnosis, no learning.
Keep the bag. Always.
What is your unit’s protocol for suspected bacterial transfusion reactions?”
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