Investigation Toolkit

Transfusion-transmitted Infections (TTI)

This toolkit is intended to be used by health departments in the event of a suspected TTI. The form includes both

  • recipient initiated investigation
  • donor initiated investigation

 

The U.S. blood supply is safer than it has ever been. However, any bloodborne pathogen has the potential to be transmitted by blood transfusion. TTIs are infections resulting from the introduction of a pathogen into a person through blood transfusion. A wide variety of organisms, including bacteria, viruses, prions, and parasites can be transmitted through blood transfusions.

The use of a standard donor screening questionnaire as well as laboratory tests help to reduce the risk of an infectious organism being transmitted by blood transfusion.

Task List

Every investigation is unique and your role as health department may change. In some instances, you may be responsible for contacting involved parties, securing donor testing, and identifying co-recipients. In other cases, the investigation may be handled primarily by the blood collection facility or the transfusion service, and your role will be to ensure that the key action items are accomplished in a timely manner.

Recipient Initiated Investigation

Notify relevant partners (i.e., blood collection agencies, hospitals, CDC, other health departments)

  1. Information on recipient
    (may be acquired from treating clinician, transfusion service, or patient interview)
    • Obtain:
      • State of residency
      • Date illness onset
      • Course of current illness
      • Past medical history, including underlying diseases
      • Treating clinician contact information
    • Confirm diagnosis if needed (may be performed at state public health laboratories, CDC, or commercial laboratories depending on suspected pathogen)
    • Evaluate patient history for potential exposures other than blood transfusion (i.e., residence in or travel to endemic area, laboratory accident, IVDU)
    • Obtain date and location (i.e., hospital, transfusion service) of recent transfusions
      Note: If blood transfusions occurred in a different state, consider notifying the health department.
    • Check on availability of specimens (both pre- and post-transfusion) for further testing to rule-in/out donor-derived transmission
      Note: If recipient has received multiple transfusions, specimens from periods of time between transfusions can be used to narrow the window of suspicion. Specimens may be available at the transfusion service or at other hospitals the patient may have visited. The recipient may be asked to give a specimen for testing at the time a TTI is suspected, so at least that specimen should be available.
    • Request pre-transfusion specimens, if available, for testing to ensure this was not a preexisting infection.
      Note: If specimens are unavailable, medical records may contain information relevant to preexisting infections (i.e., fever of unknown origin)
    • Encourage adequate and appropriate treatment (treatment decisions should be determined by the recipient’s clinician, assist as needed).
  2. Information from facility transfusion services
    • Collect contact information for transfusion service and recipient’s current medical care team (e.g. attending clinician, primary care)
      Note: May be at different facilities.
    • Acquire unit numbers, type of blood component, and associated blood centers for each transfusion received.
      Note: Some recipients may have received many transfusions with blood from many donors given at multiple blood centers.
  3. Information from blood collection facilities
    • Collect information for point of contact (POC) at the blood collection facility
    • Notify blood center of potential transfusion-associated infection and determine their SOP for donor contact and testing
    • Per usual procedures, blood centers may hold blood bag segments from the donations for testing and quarantine co-components from implicated units
    • Establish mechanism for receiving updates on donor testing with blood centers (or group that is performing the testing)
  4. Donors
    If potentially infected (e.g., seropositive) donors are identified:
    • Recommend that the donors see a health care provider for evaluation and treatment
    • If possible, conduct an interview with donors. Consider acquiring demographic information, travel history, outdoor activities, history of exposures to the agent, and clinical manifestations consistent with infection.
    • Work with blood collection facilities to identify all recent donations and where the donations were shipped for the implicated donors. Identify possible contaminated products (RBCs, plasma, etc.) within appropriate window.
      Note: The length of time and types of components to consider varies by pathogen.
    • If blood bag segments are still available, arrange for testing by blood center collection facility (may also be performed at state public health laboratories, CDC, or commercial laboratories depending on suspected pathogen)
  5. Co-Recipients/Recipients of potentially contaminated donations if blood was transfused,
    • Investigate recipients of transfused co-components from implicated donation and other potentially contaminated donations from implicated donors.
    • Examine for laboratory evidence of implicated pathogens.
    • Consider signs/symptoms and other potential exposures in recipients.
      Note: Testing for infections of unknown origin is available at CDC.
Donor Initiated Investigation

Notify relevant partners (i.e., blood collection agencies, hospitals, CDC, other health departments)

  1. Basic information on donor
    • Date and locations (i.e., blood collection facility) of recent donations 
      Note:
       If donor has multiple donations, define time periods.
      Note: If state of residency is not where the investigation was initiated, consider notifying other health departments.
    • History of clinical manifestations consistent with infection
    • Pathogen-specific exposure history
    • Confirm diagnosis if needed (may be performed at state public health laboratories, CDC, or commercial laboratories depending on suspected pathogen)
    • Encourage adequate and appropriate treatment, if indicated (treatment decisions should be determined by the donor’s clinician, assist as needed).
  2. Blood collection facilities
    • Collect contact information for point of contact (POC) at the blood centers
    • Notify blood center of potential TTI
    • Request that the blood centers hold retention segments from the donations for testing and quarantine components from donor
    • Request non-transfused components for testing
    • Obtain unit numbers and contact information for transfusion services that received units
  3. Facility transfusion services
    • Collect contact information for transfusion services at facilities where donor’s blood was sent and recipient’s medical care team (e.g., attending clinician, primary care)
    • Identify recipients of the donor’s blood components (usually done by the transfusion service). The recipient’s physician should be notified of the transfusion event and asked to cooperate in testing and gathering further data on the status of the recipient.
      Note: This is usually done through the patient’s primary care physician; not the physician that ordered the blood transfusion. If the primary care physician cannot be identified, the local health department may need to contact the patient and arrange for testing.
    • If not conducted by the health department, schedule mechanism to receive results from transfusion service or group conducting recipient follow-up
TTI Investigation Form

Recipient and Donor TTI Investigation Form pdf icon[PDF – 6 pages]
This form is designed to assist investigators in collecting information relevant to transfusion-associated cases. These are not for reporting an outbreak of disease to the CDC. For reporting assistance, refer to your State Health Department.

Instructions for completing the generic investigation form pdf icon[PDF – 8 pages]