Asian Journal of Transfusion Science

LETTER TO THE EDITOR
Year
: 2018  |  Volume : 12  |  Issue : 1  |  Page : 93--94

A curious case of thick white slick in a blood bag


Anju Dubey1, Atul Sonker2,  
1 Department of Transfusion Medicine, T.S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Anju Dubey
Department of Transfusion Medicine, T.S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh
India




How to cite this article:
Dubey A, Sonker A. A curious case of thick white slick in a blood bag.Asian J Transfus Sci 2018;12:93-94


How to cite this URL:
Dubey A, Sonker A. A curious case of thick white slick in a blood bag. Asian J Transfus Sci [serial online] 2018 [cited 2020 Aug 3 ];12:93-94
Available from: http://www.ajts.org/text.asp?2018/12/1/93/225684


Full Text



Sir,

Visual anomalies are a common occurrence in the blood components. They come into light when blood components are visually inspected before issue. The US-Food and Drug Administration issued an alert emphasizing on enhanced visual inspection of all blood components for the presence of white particulate matter (WPM) in 2003 and an AABB press release categorized them into four different patterns: Type I matter, consisting of 20–5000 small WPM per unit; Type II matter, consisting of 2–50 large WPM per unit; Type III matter, consisting of atypical bubbles; and Type IV matter, consisting of a yellow/white oil slick.[1]

Here, we report a case of visual anomaly in a packed red blood cell (PRBC) bag, 12 days old, which was detected before issuing. There were two thick whitish streaks one at the center and the other near the upper end of the bag, which were slippery in consistency and did not dissolve on gentle shaking [Figure 1]. The tubings attached to the unit contained numerous white clumps. On vigorous rubbing, the streaks disintegrated partially into opaque granularities [Figure 2] only to consolidate again on resting undisturbed for 10 min at room temperature. On retrospection, the unit was found to be collected in a double bag (M/S Mitra Industries (P) Ltd., India) and plasma was separated using hard spin. We called up the donor who was an 18-year-old male, weighing approximately 90 kg. On further investigation from a fresh blood sample, RBC, white blood cell (WBC), and platelet counts were normal. Serum protein levels were within the normal range, but low-density lipoprotein-cholesterol level was 280 mg/dl on lipid profile assay. There were no other abnormality in the lipidogram and no significant history of drug intake. The sample from PRBC unit was sent for Gram staining which gave negative results and culture was sterile. Frozen plasma bag from the same unit however showed no visual abnormality. The unit was issued after routine compatibility testing and transfused uneventfully.{Figure 1}{Figure 2}

WPM is a well-known entity composed of aggregates of platelets and WBCs in a matrix of cellular debris and fibrin. A similar case has been reported by Sachdev et al.[2] which differs from this case as there were few white particles in the PRBC bag prepared through soft spin from a donor with no lipid abnormality. This is however a case of Type IV matter according to the AABB classification which has been least frequently reported. Exact etiology is still unknown; high speed of centrifugation, nondepletion of leukocytes, increased donor platelet counts, and donor hyperlipidemia have been implicated as potential harbingers nonetheless.[3] No adverse transfusion reaction has been reported from bags containing WPM,[4] yet ruling out of other similar causes of visual anomalies by thorough investigations is warranted before issuing the blood bag.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1AABB. Key and Terminology as Relates to Atypical Blood Units. AABB Press Release. Bethesda, MD: AABB; 2003.
2Sachdev S, Dhawan HK, Khetan D, Marwaha N, Jain A, Sharma RR, et al. White particulate matter in a packed red blood cells unit. Asian J Transfus Sci 2011;5:175-6.
3Rentas FJ, Macdonald VW, Rothwell SW, McFaul SJ, Asher LV, Kennedy AM, et al. White particulate matter found in blood collection bags consist of platelets and leukocytes. Transfusion 2004;44:959-66.
4Iwamoto M, Curns AT, Blake PA, Jernigan DB, Holman RC, Lance-Parker SE, et al. Rapid evaluation of risk of white particulate matter in blood components by a statewide survey of transfusion reactions. Transfusion 2004;44:967-72.