Contaminated Information and Courses from MediaLab, Inc.

Thrombotic thrombocytopenic purpura (TTP) is an uncommon, but very serious consumptive platelet disorder. Its cause is unknown, but there are several possible precipitating factors including infection, carcinoma, and pregnancy. More women than men are affected by TTP. If left untreated, the mortality rate is in excess of 90% due to multiorgan failure. Hemolytic uremic syndrome (HUS) is also a platelet consumptive disorder. HUS is thought by some to be the same condition as TTP because both disorders have the same underlying pathology. However, HUS is more often associated with renal failure and TTP with neurological manifestations including visual impairment, weakness, headache, dizziness, disorientation. seizures, or coma. Microangiopathic hemolytic anemia, thrombocytopenia, and fever is associated with both TTP and HUS. The patient's condition can deteriorate rapidly while these symptoms are becoming evident. HUS is usually seen in children; it is the most common cause of acute renal failure in children. Patients may have bloody diarrhea and symptoms resembling colitis. Diarrhea-related HUS is usually associated with ingestion of undercooked beef contaminated with Ecoli O157:H7; it is the Shiga-like toxin from this serotype that causes the illness. Some patients may have long term kidney dysfunction as a result ofthis virulent infection. For patients who have experienced renal failure, dialysis may be required.

This is a higher power view of this same smear demonstrating a neutrophil that is filled with Toxopasma gondii tachyzoites (blue arrow).There are a few free organisms in this image well, indicated by the red arrows. Again, the typical morphology for toxoplasmsa organisms is lavender cytoplasm with a red granular cluster in the center of each parasite.This patient was negative for Toxoplasma gondii prior to a transplant but had received 15 units of blood products due to cytopenias.It is believed that a donor for one of the transfused units had been exposed to Toxoplasma gondii either through cats or contaminated food and had transient circulating Toxoplasma gondii in his or her blood when the donation was made. In this case, the recipient was profoundly immunocompromised, which lead to rapidly developing systemic disease.

Low JC. Donachie W.: A review of Listeria monocytogenes and listeriosis. Veterinary Journal. 153:9-29, 1997 Following the initial isolation and description in 1926, Listeria monocytogenes has been shown to be of world-wide prevalence and is associated with serious disease in a wide variety of animals, including man. Our knowledge of this bacterial pathogen and the various forms of listeriosis that it causes has until recently been extremely limited, but recent advances in taxonomy, isolation methods, bacterial typing, molecular biology and cell biology have extended our knowledge. It is an exquisitely adaptable environmental bacterium capable of existing both as an animal pathogen and plant saprophyte with a powerful array of regulated virulence factors. Most cases of listeriosis arise from the ingestion of contaminated food and in the UK the disease is particularly common in ruminants fed on silage. Although a number of forms of listeriosis are easily recognized, such as encephalitis, abortion and septicaemia, the epidemiological aspects and pathogenesis of infection in ruminants remain poorly understood. The invasion of peripheral nerve cells and rapid entry into the brain is postulated as a unique characteristic of its virulence, but relevant and practical disease models are still required to investigate this phenomenon.

Important safety precautions must be observed when handling cerebrospinal fluid. The following guidelines apply:Semi-automatic micropipettes and disposable plastic chambers are the safest option for CSF testing. Many laboratories still use the hemacytometer with disposable pipets.If disposable materials are not used, soak contaminated reusable pipets, hemacytometer and coverslip in 70% alcohol or Wexide.All disposable items should be placed in a biohazard container for appropriate disposal.Wash hands thoroughly when the examination is completed.Spinal fluids which are to be discarded must be placed in biohazard containers for appropriate disposal.Careful attention to specimen processing and handling will help ensure that accurate results are obtained.

In addition to the puncture device, additional equipment may be required when performing a successful dermal puncture.Plastic microcollection devices: Plastic microcollection devices are small plastic tubes designed to collect capillary blood from a dermal puncture wound. Each small collection tube is color-coded in the same manner as blood collection tubes used for venipuncture. The color of the cap of each container tube corresponds to the type of additive inside the tube, most often an anticoagulant. The additive coats the inside of the tube. Examples of microcollection devices are shown below. Heel warmer: It is best practice to warm the heel of an infant with a warming device known as a heel warmer. The heel warmer, when activated, is designed to warm its contents to a standardized temperature. This temperature will be hot enough to effectively warm the heel and facilitate blood flow to the area without causing heat injury to the patient. It is unacceptable to warm a cloth using a microwave. There may be "hot spots" on the cloth that could potentially burn the patient. Keep in mind, what may feel warm to you, the phlebotomist, may feel hot to your patient!Plastic or Mylar-wrapped capillary tube: In some facilities blood from a capillary puncture is collected directly into a capillary tube. These tubes are very delicate and must be used with great caution. As soon as the tube is two thirds to three-fourths filled, one end is sealed to prevent blood from leaking out.Glass microscope slides: In some facilities, the person collecting the capillary specimen may also be required to prepare a blood smear for laboratory examination. A drop of blood is placed directly on a glass slide and spread to create an area for cell examination. If you are required to prepare blood smears, remember that the slide is considered infectious until fixed or stained. It is also important to remember that glass is a sharps hazard. If not used correctly, the glass may cause injury to both the patient and the phlebotomist. Be as cautious with a glass slide containing blood as you are with a contaminated needle. Dispose of glass slides that will not be used for testing in approved sharps containers.Alcohol and gauze pads: Alcohol is the disinfectant of choice for dermal puncture. The alcohol must be allowed to air dry, which will prevent hemolysis of the specimen and discomfort for the patient. A piece of clean or sterile gauze is used to wipe away the first drop of blood. Gauze is also used to apply pressure to the wound after the specimen collection is complete to stop the wound from bleeding.Iodine or other approved cleaning agents may be used as an alternative to alcohol.Bandage: It may be necessary to apply a bandage to the puncture wound on a finger or heel if the site continues to bleed. However, it is NOT recommended to bandage the finger of a child who is 2-years-old or younger since the bandage may become a choking hazard if the child puts that finger in his/her mouth.Personal protective equipment (PPE): All healthcare professionals that may come in contact with blood and/or body fluids while performing a laboratory procedure are required to wear intact gloves. It is against safety guidelines to alter gloves in any way that may compromise the integrity of the gloves. Eye protection, such as safety goggles, is recommended if there is the possibility of a splash of blood while collecting a capillary blood specimen. In many facilities, special gowns are required in some patient areas such as special-care nurseries. Always follow the policies of your facility in regard to PPE.

Band AppearancePossible CauseShort Migration PatternsContaminated or Aged BufferDiffuse BandsMarkedly Wet GelsPoor Sample ApplicationStreaks Perpendicular to BandsTearing/Poking Gel in Sample ApplicationWeak BandsNot Enough SampleNot Enough StainOther Causes of Irregular and Distorted BandsHemolyzed SampleBent or Dirty ApplicatorAir Bubbles in Sample ApplicationToo Much SampleWick FlowToo Much Heat or Drying

If the chemical is a dry powder, first brush it off from the victim, taking care not to contaminate yourself, especially your eyes.Immediately flush exposed skin with large amounts of water.Remove contaminated clothing while continuing to flush the affected area with water.Continue flushing with water for 15 minutes or longer.Seek emergency medical attention.

Face shields, masks, and safety glasses protect your eyes and the mucous membranes of your nose and mouth.They must be worn whenever it is reasonably anticipated that splashing or spraying of blood or other contaminated materials may occur.Employees who wear prescription eyewear may be protected with a face shield, goggles, or with side shields attached to their glasses.

Most likely means of dissemination: Aerosol (eating contaminated food)Primary route of entry: Inhalation (oral)General signs and symptoms: Difficulty with speaking, swallowing, or blurred or double vision, drooping eyelids (ptosis), dilated pupils, dry mouth, decreased gag reflex, weakening of the reflexes (hyporeflexia), abnormal sensations such as numbness, prickling, tingling, and arm or leg weakness.Botulism is caused by a neurotoxin and technically could be classified as a chemical WMD. For our discussion it is placed under biological agents because the toxin is derived from a bacterium. Botulism is potentially life-threatening, producing a characteristic clinical picture of muscular paralysis leading to respiratory failure.                Photo courtesy of the CDC archives.    

Stay inside or get inside quickly. Find a “Shelter-in-place”. To “shelter in” is a way to make the building you are in safe as possible to protect yourself until help arrives. You should not try to “shelter in” in a vehicle unless you have no other choice. The best room to use is one with as few windows and doors as possible. Be sure to close all windows and doors, and turn off the furnace, air conditioners, and exhaust systems. As best as possible, seal all openings in windows and doors. Monitor your radio for instructions from authorities. If you believe you’ve been exposed and you can’t get to a hospital, shed all your clothes as quickly as possible. Don’t take the clothes inside because you may spread contamination. Go straight to the shower and thoroughly wash all body parts with a coarse soap. It is important not to ingest radiation by eating contaminated food or even chewing on contaminated fingernails. Also, certain types of radioactivity can be flushed from the body by drinking large amounts of water. After an attack don’t travel through heavily contaminated areas. If you can get out of the general area through an uncontaminated route, do so—otherwise, stay indoors until assistance arrives.               

Technologists fulfill assigned supervisory responsibilities as needed and as authorized. Other duties include: Performing only those tests authorized by the director and for which the technologist is licensed by specialty. Following the laboratory's procedure for specimen handling, running tests, reporting results, and maintaining records Participating in proficiency testing and demonstrating that proficiency samples are tested in the same manner as patient samples Following quality control and instrument calibration policies Documenting corrective action taken when results exceed the laboratory's acceptable performance values Using professional judgment to ensure test validity, including recollecting and retesting samples that may be flawed or contaminated

In general, the infection that develops is dependent on the virulence of the particular strain, the inoculum size, and immune status of the host. Staphylococcal infections are typically suppurative, producing abscesses filled with pus and damaged leukocytes surrounded by necrotic tissue. Skin infections range from superficial - boils, carbuncles and furuncles, to bullous impetigo; largely opportunistic infections that develop as a result of previous injury e.g., cuts, burns, surgical wounds - and scalded skin syndrome (extensive exfoliative dermatitis; also known as Ritter's Disease). Other major infections include pneumonia, osteomyelitis (localized infection of bone), and septic arthritis. S. aureus also causes food poisoning as a result of ingestion of food contaminated with an enterotoxin producing strain (enterotoxins A&D) and the potentially fatal toxic shock syndrome, a multisystem disease most often associated with the use of highly absorbent tampons. Toxic shock syndrome is attributed to another toxin (enterotoxin F – TSST1) released by certain strains of S. aureus.Human staphylococcal infections usually remain localized by the normal host defenses. Foreign objects (fomites) such as sutures or intravenous (IV) lines - are readily colonized by S. aureus from skin and can allow the organism to spread systemically via the blood stream – bacteremia/septicemia - leading to more serious infections. Staphylococcal pneumonia is becoming a frequent complication of influenza. Whatever the mode of entry, the invasive nature of S. aureus always poses the threat of more serious deeper tissue invasion and/or bacteremia and hematogenous spread.

The first step in treating patients with CDAD is to discontinue the causative agent wherever possible. The choice for initial antibiotic therapy depends on the severity of disease. Oral vancomycin or metronidazole remain the mainstays of therapy for C. difficile infection, with vancomycin reserved for patients with more severe disease and/or those who have not responded to metronidazole. Metronidazole is currently favored in guidelines from the CDC on the basis of cost and concern that oral vancomycin promotes colonization with vancomycin-resistant Enterococcus. Oral fluids (water and electrolytes) may be necessary to counteract fluid loss as a result of excessive diarrhea, which can quickly lead to dehydration. Patients with fulminant disease and toxic megacolon may require colectomy. Recurrence of C. difficile infection (CDI) is becoming an increasing problem. Most recurrences happen 7 - 14 days after completion of therapy, suggesting relapse rather than re-infection. If a patient develops a second episode of CDI following initial successful treatment, it is recommended that if possible, the same drug be used to treat the second episode. Contributing factors to recurrent CDI include: Continuing exposure to organisms either through re-infection (via contaminated environment or poor hand hygiene) or an endogenous source, such as C. difficile spores in GI tract. An inability to mount an adequate anti-Toxin A IgM and/or IgG antibody response (i.e., poor host immune response); a likely reason why CDI affects an increasingly elderly population. Unfortunately a vicious cycle can arise whereby the initial treatment prescribed, vancomycin or metronidazole, significally disrupts normal colonic flora reducing colonization resistance and leaving the patient vulnerable to the next recurrent episode.Other treatments including the use of probiotics or anion-exchange resins to absorb toxins, may work in some cases but none work in every case.The goal of all treatment is to reestablish normal colonic flora so as to control C. difficile (over)growth.

You can avoid exposure to HBV by taking the appropriate precautions, such as: Receiving the immunization against Hepatitis B Following standard precautions Maintaining proper work practices Using proper techniques when handling materials, which may be contaminated with blood or other potentially infected materials

Body fluids most likely to transmit HBV are: Blood Semen Vaginal Secretions Pleural Fluid Peritoneal Fluid Pericardial Fluid Cerebrospinal Fluid Synovial Fluid Amniotic Fluid Blood contaminated saliva in dental procedures Any fluid visibly contaminated with blood Sweat uncontaminated by blood is not considered infectious.

Occupationally, HIV can be contracted through blood and other potentially infectious materials (OPIM), in the same manner as HBV. HIV is also spread in the community in the same manner as HBV:Via a puncture with a contaminated sharp such as a needleSexual contactFrom a mother to her child before or during birth

It is important to always dispose of contaminated wastes properly.Examples of contaminated wastes: Microbiology waste and pathology waste All body fluids, such as pleural fluid Contaminated sharps and blood specimens

Put contaminated wastes that do not have the potential to puncture in a red or orange leakproof biohazard-labeled bag. If the external surface of this bag is contaminated, place it within a secondary leakproof bag.

Garments worn as personal protective equipment must meet the American Society for Testing and Materials (ASTM) standards. This will ensure that the wearer will not be contaminated if there is a splash or splatter of blood or other potentially infectious material. The outer protective garment should be fluid resistant, such as a nonwoven gown or a long-sleeved, cuffed laboratory coat with high resistance to fluid penetration. The lab coat should be fully closed when working in the laboratory.Scrub suits do not offer adequate protection.If a garment is contaminated with blood, it must be removed immediately, or as soon as it is feasibly possible.

when there is a reasonable chance of exposure to blood, other infectious body fluids, mucous membranes, or nonintact skin. during vascular access procedures, including phlebotomy. when handling contaminated items or when touching contaminated surfaces.

The following protect your eyes and the mucous membranes of your nose and mouth: Face shield Mask worn with safety glasses Employees who wear prescription eyewear may be protected with a face shield, goggles, or with side shields attached to their glasses (a mask must also be worn to protect the nose and mouth).Face and eye protection must be worn whenever it is reasonably anticipated that splashing or spraying of blood or other contaminated materials may occur. A splash guard (as shown below) is an engineering control that can be used for facial protection.

Hepatitis B most often spreads when certain body fluids from an infected individual come in direct contact with another person.Contact may occur through: a break or sore in the skin a contaminated sharp contact with mucous membranes that line the insides of the mouth, nose, eyes, and the genital organs. HBV is not spread through casual contact, such as handshake, or through sweat.

HBV is spread in the community through: Sexual contact Drug abusers sharing contaminated needles An infant's exposure to its mother's body fluids

If the outside of a sealed specimen container is contaminated, the standard requires that the specimen be placed in a secondary red/orange or biohazard labeled container.

Contaminated sharps must be placed in puncture resistant, leak-proof, closable, biohazard labeled containers.These must be closed when only three quarters full, to prevent sharps from sticking out of the opening, and must be disposed of properly.

Remove contaminated personal garments as soon as possible.Do not take your contaminated garments home.Your employer will launder them and provide you with clean clothes to wear.Handle contaminated laundry as little as possible.

Gloves must be worn: when there is a reasonable chance of exposure to blood, other infectious body fluids, mucous membranes, or nonintact skin, during vascular access procedures, including phlebotomy, or when handling contaminated items or surfaces.

Even after taking all the proper precautions there is still a small chance of an exposure incident.Exposure incident: Blood or another potentially infectious body fluid coming into direct contact with mucous membranes or nonintact skin.Parenteral exposure: Needle stick or being cut by a contaminated sharp.

Should you become contaminated with formaldehyde, a quick drench shower and an eye wash station are available in your area. If you splash formadehyde solution on your face or in your eyes, use the eyewash station to wash your eyes and face with copious amounts of water, occasionally lifting upper and lower lids, until all formalin is removed (at least 15 minutes).If your skin becomes contaminated, flush with water and soap for at least 15 minutes. If your clothing becomes saturated with formalin, remove it and place it in a sealed bag for decontamination.

Should you become contaminated with formaldehyde, a quick drench shower and an eye wash station are available in your area.Ask your supervisor for their exact location and how they work.

This phlebotomist violated hospital procedures in several ways that could adversely impact patient care: Cleaning the site only with alcohol, not iodine, could result in a false-positive contaminated blood culture. This might result in the patient receiving unnecessary intravenous antibiotics, and could prolong the patients hospital stay unnecessarily. Drawing both cultures at the same time lessens the chance of recovering a bloodstream organism.Drawing both cultures from the same site might result in both of them being contaminated, making it very difficult for the physician to distinguish contamination from a "real" bloodstream infection.Relevant topics:Blood cultures: introduction, Avoid skin contamination, Blood culture site preparation 1, Blood culture site preparation 2

Bloodborne pathogens are infectious micro-organisms which live in the bloodstream.You can be exposed to bloodborne pathogens if you are injured with a contaminated needle.You can also be exposed if your mucous membranes, including eyes, mouth, or the inside of your nose come into contact with contaminated body fluids.

These organisms can be encountered outside of a bioterrorism event and produce human disease. It's important to be familiar with the geographic areas where these organisms naturally occur and the how disease is transmitted.Bacillus anthracis: Bacillus species inhabit the soil, water, and airborne dust. Anthrax is the disease produced, which is transmitted to humans via direct contact with infected herbivorous animals. This is where the disease is primarily encountered. Anthrax is controlled in animals in the United States, so the disease is rare. In humans, most cases are cutaneous infections found in people that handle animals and animal products, including veterinarians and agricultural workers. Anthrax is consistently present in the animal population of some geographical regions, such as Iran and Pakistan, but only small numbers of animals experience the disease at any given time. Yersinia pestis: Y. pestis is found primarily in rodents, but can also be found in several animal species, such as cats, rabbits, camels, squirrels. Animal to human transmission most commonly occurs via a flea bite, causing the most common form of the disease known as the bubonic plague. Human-to-human transmission occurs by either flea bite or respiratory droplets. This causes an overwhelming disease known as pneumonic plague, which is the most likely form that would be implicated in the event of a bioterrorist attack. Human cases of the plague continue to occur in many countries, including Africa, the southwestern United States, parts of Asia, and the former Soviet Union. Francisella tularensis: Many animals, including rodents, rabbits, deer, and raccoons act as host for this organism. Humans and domesticated animals, such as horses, cattle, cats, and dogs can become infected. The infection is transmitted to domesticated animals by ticks and biting flies. Humans are most commonly infected from the bite of an infected tick or fly. Other means of infection include direct contact with the blood of infected animals when skinning game, eating contaminated meat, drinking contaminated water, or inhaling the organisms produced by aerosols. F. tularensis carries a high risk of laboratory acquired infection and documented cases of infection have occurred. Most cases of tularemia are reported in the southern and south-central United States.

Prior to culturing a sputum specimen, a Gram stain should be performed to evaluate the quality of the specimen. One of two criteria are currently used to determine if the specimen is contaminated with oral flora organisms, which would make the specimen unsuitable for culture. One criterion states that the sputum specimen should be rejected if 25 or more squamous epithelial cells/low power field (SQE/LPF) are observed. The second criterion recommends a cutoff of more than 10 SQE/LPF. In either case, a minimum of 20 LPFs should be observed. Review and follow your laboratory's criteria.The low power microscopic field on the right is representative of 20 microscopic fields that were reviewed on this Gram-stained preparation of sputum. This specimen would be considered unacceptable for culture. If the specimen is determined to be a sub-optimal specimen, the clinician should be contacted and a request should be made for a new specimen. It is important to communicate that culturing the specimen that was provided will not yield useful information about the possible pathogens from the lower respiratory tract. If the specimen is determined to be a good quality, lower respiratory tract specimen, continue to examine the slide under oil immersion (1000X) magnification for bacteria, yeast, and polymorphonuclear white blood cells (PMNs) and proceed with culturing the specimen.

Epithelial cells in large numbers within sputum smears means that the specimen is predominantly oral saliva, rather than true sputum from the lung. Epithelial cells in urine smears indicate that the sample has been contaminated by organisms found on the vulva or distal urethra. Bacteria found near or on epithelial cells are usually normal contaminating bacterial flora.White blood cells indicate inflammation and possible infection. The direct smear examination should focus within and around these cells.Red blood cells in a direct smear are not usually significant.Yeast may be present as normal flora in upper respiratory tract or genital tract. They may be significant if they predominate, or if budding yeast forms are seen.Hyphae are more likely to indicate the presence of fungal infection, but this determination requires correlation with clinical findings.Bacteria found in spinal fluid, blood, tissue and specimens from other sterile sites are always significant.Body fluids which are normally sterile must be examined carefully. If only one organism per oil immersion field is identified, then there are about 105 organisms per mL present in the sample! Bacteria observed in specimens from the throat, genital tract and other areas containing normal flora suggest infection only if their composition and type varies significantly from the norm.

The safety of both the phlebotomist and patient is of utmost concern at all times. In the unfortunate event of an accidental needlestick or if you get blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if available. Report this immediately to your employer and seek immediate medical attention. It is imperative that the phlebotomist follow facility protocol for reporting the incident. This ensures prompt treatment for the injury. The facility procedure must be followed whether the accidental puncture was from a clean or contaminated needle.The single most important element to prevent an accidental needlestick is for the phlebotomist to fully concentrate during every procedure. Keeping your mind on the task at hand contributes to a successful and safe result.

Safety precautions should be observed when handling seminal fluid. The following guidelines should be followed:If non-disposable items are used, soak contaminated items(e.g., hemocytometers and coverslips) in 70% alcohol or other appropriate decontaminate.All disposable items should be placed in a biohazard bag.Non-latex or powder-free latex disposable gloves must be worn and hands thoroughly washed when the examination is completed.Seminal fluids that are to be discarded should be placed in biohazard bags.

An arterial line or vascular access device (VAD) is used to provide easy access to a patient's circulatory system for administration of fluids and medications. Occasionally, blood specimens are drawn from a VAD, but phlebotomists are not usually authorized to collect these specimens. However, phlebotomists may sometimes assist when a clinical person is collecting blood from a VAD. If you are present, be certain that the person performing the collection flushes the line with at least 5 mL of saline and the first 5 mL of blood is discarded before collecting the sample. If this procedure is not followed, the specimen may be contaminated with heparin that was used to flush the line or be diluted. This could cause inaccurate test results.

The Influenza A 2009 H1N1 virus spreads from person to person in a similar way to the seasonal flu in previous years.The primary route of influenza virus transmission and infection are by respiratory droplets and aerosols. Transmission may also occur via contaminated hands (person-to-person) and surfaces. Infected individuals can shed the virus and spread Influenza A 2009 H1N1 to others anywhere from 1 day prior to getting sick up until 5-7 days after symptoms arise. This range of viral shedding can be even longer in children and in some individuals who are immunocompromised.

When the slides go from the xylene in the deparaffinizing step to the first alcohol in the hydration sequence, the sections should turn slightly opaque. If there are clear patches present then the deparaffinization was incomplete. Possible Causes: Water still on the slides after the drying oven Xylene contaminated with waterRemedies: Remove excess water by putting the slides back in the oven or into 100% alcohol Change reagents regularly to ensure that the xylenes stay water-free Drain slides well before transferring them to the next reagent

The last dehydrating alcohol must be 100% to ensure that absolutely no water will be carried into the following clearing agent. If the clearing xylene is contaminated with water it will appear milky-white and the slides will not clear. Remedy:Once the slides have gone into a contaminated clearing agent the only remedy is to bring them backwards to water and then dehydrate and clear them again in fresh solutions. The xylene in the coplin jar on the left side of the image is contaminated with water. Note how cloudy it is compared to the one on the right which is not contaminated.

Yersina entercolitica is most likely responsible for septic reactions in transfusions of Red Blood Cells. This organism is usually acquired by ingestion of contaminated food and causes mild symptoms of abdominal pain and diarrhea. Growth of Y. entercolitica is enhanced in iron-rich environments such as red blood cells. Other organisms reportedly found in Red Blood Cell units are Campylobacter species, Serratia species, Pseudomonas species, Enterobacter species, and Echerichia coli. These bacteria can produce endotoxins which cause a reaction in the patient. The majority of organisms associated with platelets transfusions are normal skin flora. Staphylococcus aureus, coagulase-negative staphylocci, aerobic and anerobic diptheroid bacilli, streptococci, and gram-positive bacilli are frequently isolated. Some transfused organisms have been implicated in a delayed post-transfusion illness. Pseudomonas aeruginosa and Burkholderia capacia have been isolated in cryoprecipitate and plasma. These organisms grow optimally at 30oC and have been found in water baths, accentuating the importance of overwrapping components that are thawed in a water bath. Rickettsia organisms are intracellular bacteria which are transmitted by ticks or insects. These bacteria are the causes of Rocky Mountain spotted fever, ehrlichiosis, and scrub typhus, and may be transmitted by transfusion. Similarly, the organism which causes Lyme disease may be transmitted as well. There have no reports of either of these organisms transmitted by transfusion.