Universal leukoreduction of cellular blood components in 2001? No.

Abstract

Leukocytes are known to have a number of biologic effects associated with allogeneic blood transfusion ❚Table 1❚. The potential clinical importance of these effects, which are the focus of current debate over the merits of “universal” leukocyte reduction (leukoreduction; cellular components with <5 × 106 leukocytes) include the following: febrile-associated transfusion reactions (FATRs), transfusion-related alloimmunization to platelets, and transfusion-related immunomodulation. Several recent reviews1,2 of this topic, along with commentaries3-6 about the use of leukocytedepleted blood components, have been published. The Blood Products Advisory Committee (BPAC) to the US Food and Drug Administration (FDA) voted 13-0 on September 18, 1998, in favor of universal leukoreduction of blood components,7 but the minutes stated that many committee members agreed there were insufficient good studies, and everyone wanted more data.8 To date, both leukoreduced and nonleukoreduced blood components remain FDA-approved. This commentary will summarize my view of this controversy and the need for additional controlled clinical trials to provide data to resolve this issue. ❚Table 2❚ summarizes the percentage of blood components transfused that were leukoreduced in the United States in 1994 and 1997. The percentages for RBCs (17.6% and 18.3%) and platelets (16.5% and 15.5%) remained static, despite commercial advertisements to clinicians about leukocyte-depletion filters during this period.9 For the first 9 months of 1999, 3,592 (13%) of 27,663 RBC units transfused at our hospital were leukoreduced; our indications for leukoreduction reflect those published previously,4 and are summarized in ❚Table 3❚. FATRs occur in only 0.5% of RBC transfusions; of these, 18% and 8% of patients experience a second or third FATR.10 Approximately 18% of platelet transfusions are