Although the article by AuBuchon and associates [1] nicely reviews the risk for viral transmission through the U.S. blood supply, it does not discuss the risks for bacterial transmission and the efforts associated with surveillance for and detection of bacterial pathogens. Transfusion-associated bacterial disease, a condition with rapid onset of illness and a high mortality rate, remains a serious problem that has not been adequately evaluated. Reports of sepsis and death after transfusion of blood products contaminated by bacteria, particularly Yersinia enterocolitica, have been increasing [2, 3]. During 1986 to 1991, 16% (29 of 182) of all transfusion-associated deaths reported to the U.S. Food and Drug Administration (FDA) were associated with bacterial contamination of blood products [4]. The FDA requires that only fatal complications of blood collection or transfusion be reported; thus, the number of infectious complications associated with nonfatal reactions to blood product transfusion are probably underestimated. Lack of knowledge about bacterial contamination as a cause of transfusion reaction may be another reason for underreporting. For instance, awareness of bacterial contamination as a potential cause of transfusion reaction at one hospital increased dramatically after a cluster of transfusion reactions associated with bacterially contaminated platelets was detected [5].

The rate of bacterial contamination of blood products in the United States is currently unknown, and no attempt has yet been made to systematically collect nationwide data on the prevalence of these events. Thus, the American Association of Blood Banks, the American Red Cross, the Centers for Disease Control and Prevention, and the Department of Defense are initiating a collaborative study in cooperation with blood collection facilities, transfusion services, and clinical personnel nationwide to assess the frequency of blood component bacterial contamination associated with transfusion reaction (BaCon Study). Establishment of this active reporting system will determine the etiologic agents of, risk factors for, and outcomes of transfusion reaction associated with bacterial contamination; increase awareness of the problem; and provide direction for future preventive interventions.