Autologous Predeposit: To Leukocyte Deplete Or Not to Leukocyte Deplete?

Abstract

In five studies comparing different forms of storage of autologousblood the allogenic transfusion rate, humoral and cellular immuneparameters and the postoperative infection rate were investigated.In a prospective, randomized study 21 volunteers donated one unitof blood. Retransfusion of stored autologous whole blood, but notof autologous packed red cells and fresh frozen plasma, induced alimited response of the immune system. Four prospective, randomized,partially or totally blinded studies investigating autologous donationin primary hip arthroplasty were carried out: In the first studyincluding 94 patients, in which autologous blood was stored aswhole blood, leukocyte-depleted whole blood or as blood components,the allogenic transfusion rates were compared. The type ofstorage of autologous blood did not influence homologous transfusionrequirements. In a second study dealing with humoral immunefactors, 97 patients were allocated at random to two groups. In onegroup, the autologous donation was stored as whole blood, in theother group the donation was separated into blood components beforestorage. With respect to the parameters studied, there were nosignificant differences between patients transfused with wholeblood and those transfused with blood components. Moreover,these values also did not differ from those of patients not transfused.In a third study, the phagocytosis and respiratory burst activityof neutrophil granulocytes and of monocytes was measured in58 patients who were randomly allocated to two groups as in theprevious study. Neither the time course of phagocytosis nor that ofrespiratory burst activity showed a significant difference betweenboth groups. In a fourth multicenter study, 953 patients were allocatedto either of two groups. The first group of patients receivedautologous blood stored as whole blood, in the second groupleukocyte depletion was done before storage. When comparing theoutcomes of both groups, it could be shown that leukocyte depletionof autologous whole blood did not reduce the number of postoperativeinfections in primary hip surgery. It is therefore concludedthat neither leukocyte depletion nor blood component separationis mandatory when using autologous predeposit in primary hiparthroplasty.