A fatal case of post-transfusion sepsis caused by Yersinia enterocolitica after delivery

In recent years there has been a progressive strengthening of the safeguards that protect patients from unsuitable blood products. Blood donors are asked several questions concerning possible risk factors that may affect the safety of the donated blood and are deferred from donation if some of them are acknowledged. Moreover, blood donations are tested for numerous infectious agents, which has led to a significant reduction of viral infections after blood transfusion. However, bacterial sepsis remains a significant hazard of transfusion. Among all blood components, red blood cell preparations are the most used and they are more frequently infected by Gram-negative bacteria, primarily members of the Enterobacteriaceae family. Yersinia enterocolitica (Y. enterocolitica) is not inhibited in the range of 2–6 °C, which is the storage temperature of red cell concentrates. This, in addition to the pH of preparation of red blood cell units (7.3), supports bacterial growth. Here we report a fatal case involving a woman, who had haemorrhagic shock in the early post-partum period. She required the transfusion of seven bags of red blood cells which, shortly after, led to the onset a Y. enterocolitica post-transfusion sepsis with a fatal outcome. In this case, the microbiological investigation performed on cadaveric blood supported the diagnosis of sepsis-related death. The presumably infected transfused red cell concentrate was identified by detection of high titres of antibodies against Y. enterocolitica in the donor’s plasma.