Cryoprecipitate contaminated with Cupriavidus pauculus: A rare cautionary case report.

AIMS: The aim was to define the source of contamination of cryoprecipitate intercepted during visual inspection before transfusion.

MATERIALS AND METHODS: A clot was observed in one unit of cryoprecipitate before blood transfusion at the Dongyang People's Hospital. Bacterial cultures were performed using the BacT/ALERT system (BacT/ALERT 3D, bioMerieux, Durham, NC). The isolated bacteria were identified through conventional biochemical identification, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and molecular analysis based on 16sr RNA. Samples from all individuals who came into direct contact with the cryoprecipitate were cultured, and the positive samples were then referred for bacterial identification.

RESULTS: A leak was found at the edge of a blood bag containing the cryoprecipitate. Cupriavidus paucula was identified both in the cryoprecipitate and water from the water bath. However, there was no growth of C. paucula in the samples obtained from the red blood cell suspension co-component, puncture site of the blood donor, blood storage refrigerator, transport case, and centrifuge.

CONCLUSION: C. paucula in the water from the water bath contaminated the cryoprecipitate through the invisible slit in the blood bag during thawing. Regular disinfection of water baths, double-bagging of blood products during thawing, and careful screening of blood products before transfusion should be performed to prevent the transfusion of contaminated cryoprecipitate.