Transfusion-associated adverse reactions (TAARs) and cytokine accumulations in the stored blood components: the impact of prestorage versus poststorage leukoreduction.

Hsiu-Chen Lin,Chih-Chun Chang,Yi-Ting Chen,Tzung-Hai Yen,Fang-Yi Cheng,Fang-Yeh Chu,Ming-Jang Su,Tai-Chen Lee

doi:10.18632/oncotarget.23136

Abstract

Leukoreduction in blood units could prevent patients undergoing transfusions from transfusion-associated adverse reactions (TAARs) such as febrile nonhemolytic transfusion reactions (FNHTRs). However, the effect of prestorage and poststorage leukoreduction on TAARs and its underlying mechanisms in stored blood components remains to be determined. Therefore, we investigated the impact of prestorage leukocyte-reduced (pre-LR) and poststorage leukocyte-reduced (post-LR) blood products, including red blood cells (RBCs) and apheresis platelets (PHs), on the incidence of FNHTRs and other TAARs in patients who received transfusions from 2009 to 2014 in a tertiary care center. We also investigated the difference of leukocyte-related bioactive mediators between pre- and post-LR blood components. The results indicated that prevalence of TAARs was significantly reduced in the transfusions of pre-LR blood components. Particularly, the prevalence of FNHTRs was significantly reduced in the pre-LR RBC transfusions and the prevalence of allergy reactions was markedly reduced in the pre-LR PH transfusions. Furthermore, in vitro evaluation of cytokines in the pre- and post-LR blood components revealed that IL-1β, IL-8 and RANTES levels were significantly elevated in the post-LR RBCs during the storage. In contrast, IL-1β, IL-6 and IL-8 levels were significantly elevated in the post-LR PHs during the storage. These findings suggested that prestorage leukoreduction had a diminishing effect on the development of TAARs, which could be associated with less accumulation of cytokines in the stored blood components.

Highlights

With the advance in transfusion medicine, blood transfusions are considered to be safe in general
In vitro evaluation of cytokines in the pre- and poststorage leukocyte-reduced (post-LR) blood components revealed that IL-1β, IL-8 and RANTES levels were significantly elevated in the post-LR red blood cells (RBCs) during the storage
The unit number with reported febrile nonhemolytic transfusion reactions (FNHTRs) was significantly higher in the post-LR RBCs than that in the prestorage leukocyte-reduced (pre-LR) RBCs [65 (0.49%) vs. 24 (0.23%) units, p = 0.001]; and between the pre- and post-LR RBC transfusions, there was no significant difference of the unit number with reported allergic reactions [38 (0.37%) vs. 50 (0.38%) units, p = 0.850] and other transfusion-associated adverse reactions (TAARs) rather than FNHTRs and allergic reactions [18 (0.17%) vs. 20 (0.15%) units, p = 0.680]

Summary

Introduction

With the advance in transfusion medicine, blood transfusions are considered to be safe in general. It is believed that leukocytes and the bioactive mediators (mainly cytokines) generated by leukocytes in the transfused blood units are greatly involved in the etiology of FNHTRs and other TAARs [6]. Since the 1990s, universal prestorage leukoreduction in blood components has been performed in some advanced countries [9]; and accumulating evidence indicated that transfusions with prestorage leukoreduced blood units remarkably reduced the rate of FNHTRs [4, 5]. Rare evidence indicated that whether there were significant differences between the effects of prestorage leukocyte-reduced (pre-LR) and poststorage leukocyte-reduced (post-LR) blood components on the frequency of FNHTRs and other TAARs. The expression of cytokines in blood components with prestorage and poststorage leukoreduction, as well as its association with the incidence of TAARs, remained to be disclosed

Methods

Results

Conclusion