Leukocyte Reduction Filters Research Articles

Hypotensive Reactions Associated with Platelet Transfusion Through Leukocyte Reduction Filters

Hypotensive Reactions Associated with Platelet Transfusion Through Leukocyte Reduction Filters

Leukocyte-reduced blood transfusions: perioperative indications, adverse effects, and cost analysis.

Leukocyte-reduced blood transfusions: perioperative indications, adverse effects, and cost analysis.

Laparoscopic surgery with intraoperative autologous blood transfusion in patients with heavy hemoperitoneum due to ectopic pregnancy

Patients with ectopic pregnancy complicated by heavy hemoperitoneum generally undergo immediate laparotomy, and homologous blood transfusion is sometimes started before the operation. Two women underwent laparoscopic surgery for heavy hemoperitoneum (2600 and 1900 ml) due to ectopic pregnancy. The aspirated blood was reinfused during operation through a leukocyte-reduction filter after lavage with an autologous blood-salvage transfusion apparatus.

白血球除去フィルター使用輸血における同種免疫感作の頻度と危険因子 プロスペクティブ研究

Seventy-eight patients multitransfused using leukocyte-reduction filters at bedside were prospectively studied to determine the rate of post-transfusion alloimmunization and its risk to platelet transfusion. HLA- and HPA-antibodies were detected by standard lymphocytotoxicity test (LCT), antihuman globulin-lymphocytotoxicity test (AHG-LCT) and mixed passive haemagglutination method (MPHA).Of these 78 patients, all of whom had a negative antibody screening on admission, 11 (14%) developed HLA antibodies but only one (1%) developed an HPA antibody. HLA antibodies were detected in 9 (24%) of 38 patients with previous transfusion, pregnancy or both but in only 2 (5%) of 40 patients with no presensitization (p<0.02). Among children (<20 years), one (3%) of 35 patients developed HLA antibodies whereas 10 (23%) of 43 adult patients (≥20 years) developed HLA antibodies (p<0.01). An HPA antibody (anti-HPA-2b) was detected with multireactive HLA antibodies in a woman with previous pregnancy.We conclude that WBC-reduced transfusions decrease primary immunization for HLA and HPA antigens. In presensitized adults, however, these transfusions may provide sufficient antigenic stimulation to boost or sustain a secondary alloimmune response. Women with previous pregnancy were identified as a high-responder group with regard to alloimmunization.

血小板輸血時アナフィラキシー症状が出現し，抗ＩｇＡ２ｍ（１）抗体と抗Ｃ９抗体が陽性であった１例

We describe our experience with a 51 year-old Japanese male with hypereosinophilic syndrome and granulocytic sarcoma in whom anaphylaxis had developed several times after transfusions of platelet concentrates. Electric charge of leukocyte-reduction filters or eosionophil counts in the peripheral blood did not show any relationship with anaphylaxis in this patient. Antibodies against IgA2m (1) and C9 were identified by western blotting analysis, but deficiency of IgA2 subclasses or C9 was not detected. These antibodies remain to be studied in regard with transfusion-related anaphylaxis. Because the cause of anaphylaxis following platelet transfusion has not been elucidated in most instances, it should be studied in individual cases to prevent this adverse effect in patients requiring transfusions.

Hypotension and Bedside Leukocyte Reduction Filters

Hypotension and Bedside Leukocyte Reduction Filters

From the Food and Drug Administration.

From the Food and Drug Administration.

Polymerase chain reaction based assessment of leukoreduction efficacy using a cytomegalovirus DNA transfected human T-cell line.

Detection of CMV DNA by PCR in seropositive blood donors is affected by nucleic acid extraction, amplification conditions and PCR product detection sensitivity. Clinical studies have shown that leukoreduced blood products are as effective as CMV-seronegative blood products in minimizing transfusion-associated CMV infection. We developed a PCR-based test model to assess the efficacy of leukoreduction on the removal of CMV DNA from blood donations. Whole blood units were spiked with a human Jurkat T-lymphocyte cell line which had been stably transfected with a CMV DNA immediate early sequence. All blood units were either CMV seronegative or shown to be CMV PCR negative. The amount of CMV DNA by PCR before, during and after filtration of blood units with third-generation leukocyte reduction filters were determined using a semi-quantitative adaptation of the Digene SHARP Signal System Assay (DSSSA). Whole blood units spiked with 1-2 x 10(6) CMV transfected Jurkat cells contained no detectable CMV DNA after leukoreduction. With a higher inoculum of 2.9 x 10(8) transfected Jurkat cells per unit, CMV DNA was detected after leukoreduction; however, there was an approximate 3 log decrease in the amount of CMV DNA detected. This CMV DNA transfected human Jurkat cell line in conjunction with semi-quantitative CMV PCR may be used to model leukoreduction efficacy and provides evidence that leukoreduction of blood products can decrease the amount of cellular CMV DNA by approximately 3 logs.

Hypotensive Reactions Associated with Platelet Transfusions and Angiotensin‐Converting Enzyme Inhibitors

Abstract Background and Objectives: To determine the cause of hypotensive reactions associated with platelet transfusions in coronary artery bypass surgery patients. Materials and Methods: Platelet transfusion reactions that occurred during a 3‐month period were retrospectively reviewed. Results: Eighteen transfusion reactions occurred in 16 patients. Sixteen of the reactions were hypotensive, and occurred in 14 patients transfused with platelets through negatively charged bedside leukocyte reduction filters. All 14 patients had received angiotensin‐converting enzyme (ACE) inhibitors prior to transfusion. Conclusion: Preliminary findings suggest a new type of transfusion reaction associated with the use of negatively charged leukocyte reduction filters during platelet transfusions to patients on ACE inhibitors.

Hypotensive Reactions Associated with Platelet Transfusions and Angiotensin-Converting Enzyme Inhibitors

Background and Objectives: To determine the cause of hypotensive reactions associated with platelet transfusions in coronary artery bypass surgery patients. Materials and Methods: Platelet transfusion reactions that occurred during a 3-month period were retrospectively reviewed. Results: Eighteen transfusion reactions occurred in 16 patients. Sixteen of the reactions were hypotensive, and occurred in 14 patients transfused with platelets through negatively charged bedside leukocyte reduction filters. All 14 patients had received angiotensin-converting enzyme (ACE) inhibitors prior to transfusion. Conclusion: Preliminary findings suggest a new type of transfusion reaction associated with the use of negatively charged leukocyte reduction filters during platelet transfusions to patients on ACE inhibitors.

Influence of the red blood cell preparation method on the efficacy of a leukocyte reduction filter.

The performance of a leukocyte reduction bedside filter with different types of RBC concentrates was analyzed. Three types of RBCs were prepared: buffycoat-depleted RBCs suspended in saline-adenine-glucose-mannitol (SAGM)-additive solution (BC-RBCs; n = 20), RBCs suspended in SAGM-additive solution without buffy coat removal (SAGM-RBCs; n = 20), and RBCs drawn in CPDA-I conservative solution and processed for component preparation by the platelet-rich plasma method (CPDA-RBCs; n = 20). The units were filtered within 8 h of collection. One filter was used for every 2 units. High numbers of residual WBCs were found even in the units filtered first. Filtration of CPDA-RBCs resulted in a higher residual WBC content than SAGM-RBCs or BC-RBCs (p = 0.0032 and p = 0.0002, respectively). The filter performance strikingly decreased when the WBC load per filter exceeded 4 x 10(9) or the platelet load was less than 100 x 10(9). We conclude that filter performance varies with the WBC and platelet content of the RBC concentrates. Under the experimental conditions assayed in this study CPDA-RBCs are the least appropriate ones to be used for bedside leukocyte reduction.

赤血球製剤用白血球除去フィルター処理によるＢｒａｄｙｋｉｎｉｎの産生

We have previously reported bradykinin (BK) generation during filtration of platelet concentrates with leukocyte-reduction filters made of polyester fibers with a negative zeta-potential through contact activation. In the present study we investigated whether BK was generated when red cell concentrates containing MAP (RC-MAP) was filtered with 7 different leukocyte-reduction filters (Filters A-G) made for red cell concentrates.Mean BK level in RC-MAP stored one day was 39.8±78.8pg/ml before filtration. However, concentration increased several thousand-fold to ng/ml levels during filtration with Filters A-F with a negative zeta-potential. In contrast, generation of BK was suppressed during filtration with Filter G with a positive zeta-potential to a maximum level of 601±350pg/ml.As the pre-filtration storage period of RC-MAP was extended, BK levels after filtration with Filter A decreased with 95% suppression and almost no BK generation observed in RC-MAP stored for 20 or 43 days. As the post-filtration storage period of RC-MAP was extended, BK levels after filtration with Filter A decreased to pre-filtration levels in 3 hours. Further, kallikrein levels in RC-MAP increased significantly and high molecular weight kininogen levels decreased after filtration with Filter A.The clinical significance of this BK generation during filtration remains unclear, but should be considered with regard to the clinical application of leukocyte-reduction filters.

Providing leukocyte-reduced platelets using the CS-3000 plus

Reducing leukocyte (WBC) contamination of platelet (PLT) concentrates diminishes some adverse effects associated with transfusions. To provide WBC-reduced PLTs, we initiated a program using bedside filtration. However, the inability to easily quantitate WBC removal and PLT loss at the bedside prompted us to perform filtration in the blood bank. To establish optimal methods, production of WBC-reduced PLTs using the CS-3000 PLUS was studied in three phases, during which technical modifications were made. During phase 1, prestorage WBC reduction was performed using the PALL LRF-10H filter, sterilely connected. WBC reduction was satisfactory, but PLT loss was excessive. During phase 2, the PLT-30 collection chamber and Fenwal Closed System Apheresis Kit with Integral Sepacell Leukocyte Reduction Filter were used. PLT yields were improved, but now WBC contamination was excessive. During phase 3, the interface offset was reduced from 10 to 6, and both PLT yields and WBC reduction were satisfactory. Using this final method (CS-3000 PLUS, PLT-30 collection chamber, integral filter and offset setting of 6), the mean PLT yield per unit is 4.29 x 10(11) (N = 1,146), and the mean WBC contamination is 0.50 x 10(6) (N = 32).

Providing leukocyte‐reduced platelets using the CS‐3000 plus

Reducing leukocyte (WBC) contamination of platelet (PLT) concentrates diminishes some adverse effects associated with transfusions. To provide WBC-reduced PLTs, we initiated a program using bedside filtration. However, the inability to easily quantitate WBC removal and PLT loss at the bedside prompted us to perform filtration in the blood bank. To establish optimal methods, production of WBC-reduced PLTs using the CS-3000 PLUS was studied in three phases, during which technical modifications were made. During phase 1, prestorage WBC reduction was performed using the PALL LRF-10H filter, sterilely connected. WBC reduction was satisfactory, but PLT loss was excessive. During phase 2, the PLT-30 collection chamber and Fenwal Closed System Apheresis Kit with Integral Sepacell Leukocyte Reduction Filter were used. PLT yields were improved, but now WBC contamination was excessive. During phase 3, the interface offset was reduced from 10 to 6, and both PLT yields and WBC reduction were satisfactory. Using this final method (CS-3000 PLUS, PLT-30 collection chamber, integral filter and offset setting of 6), the mean PLT yield per unit is 4.29 × 1011 (N = 1,146), and the mean WBC contamination is 0.50 × 106 (N = 32). © 1996 Wiley-Liss, Inc.

Transfusion strategies: opportunities for improvement.

Opportunities for improving transfusion practice that involve patient care, technological advancements, and technology changes in the clinical arena are discussed. Patient care should be enhanced by optimizing transfusion therapy and the source of donors of platelet concentrates, i.e., single donor platelets (obtained by plateletapheresis from a single donor) or to random donor platelets (containing a pool of six to eight platelet concentrates separated from whole blood donations). The availability of "third-generation" leukocyte-reduction filters provides the technology for significantly and consistently providing leukocyte-reduced blood components. The potential benefits of using these filters is presented. Platelet crossmatching represents a technology change involving clinical practice. Suggestions for incorporating this test into platelet transfusion algorithms are included.

Research and development in the blood bank: efforts of a hospital donor center to improve efficiency of in-line leukocyte reduction filters for automated plateletpheresis.

In-line leukocyte reduction filters (LRF) are available for use with an automated plateletpheresis (PPH) system. Initially, 62% of PPH units produced with such a filter (LRF6, N = 29) had postfiltration (POF) white blood cell (WBC) counts < 5 x 10(6), with a mean POF WBC of 42 x 10(6). In an attempt to decrease POF WBCs, PPH were rested 30 to 60 minutes before filtration with LRF6. A new, larger-volume LRF (LRF10) was also assessed for its efficiency of leukodepletion. A total of 625 PPH, 490 filtered with LRF6 and 135 with LRF10, were evaluated using prefiltration (PRF) and POF samples. Mean prefiltration WBC loads averaged 80 x 10(6) (range, 60-88 x 10(6)) using seven combinations of filters, collection software, and PRF rest periods. Ninety-three percent of PPH units rested prior to filtration with LRF6 (N = 237) had < 5 x 10(6) WBC POF, with a mean of 5 x 10(6) WBC POF. All PPH units filtered with LRF10 (N = 135), whether rested or not, had < 5 x 10(6) WBC POF, with a mean WBC count of 0.2 x 10(6) POF. Mean platelet (PLT) yields POF ranged from 3.1 to 3.4 x 10(11). A PRF rest decreased mean POF WBC counts in products filtered with LRF6. The LRF10 consistently produced PPH with < 5 x 10(6) WBC POF. Blood centers must thoroughly validate equipment utilized in the production of blood components.

Adsorption of anaphylatoxins and platelet-specific proteins by filtration of platelet concentrates with a polyester leukocyte reduction filter.

Anaphylatoxins generated during storage of platelet concentrates (PCs) may potentially have side effects on platelet transfusion. We evaluated the anaphylatoxin-scavenging abilities of white blood cell reduction filters. Among the commercially available filters for PCs, one made with polyester fiber (PL50) dramatically adsorbed C3a and C4a anaphylatoxins to the respective mean level of 1,721-208 ng/ml and 1,240-141 ng/ml in 3-day-old PCs. C3a and C4a were measured as the native and des Arg form of each complement by radioimmunoassay. C3a and C4a anaphylatoxins in the supernatant plasma fraction from 3-day-old PC again decreased from 1,136 to 114 ng/ml and from 1,086 to 65 ng/ml, respectively. The filter also adsorbed 85% of platelet factor 4 (PF4) and 31% of beta-thromboglobulin (beta-TG), which had been released from platelets into the plasma during storage. The plasma levels of adhesive proteins such as fibronectin, fibrinogen, and von Willebrand factor, and plasma lactate dehydrogenase activity did not decrease after filtration. Another polyester filter (PL5A), on the other hand, significantly increased C3a and C4a levels with filtration. In addition, there was no PF4 adsorption ability during the filtration. The filters for red cells (RC50, BPF4, and R500A) had no anaphylatoxin adsorption capabilities. The observed specific adsorption of anaphylatoxins might be attributed to the electrostatic force between the positively charged anaphylatoxins with high pI and the possibly negatively charged filter membranes. Since PF4 and beta-TG have positively charged moieties in the C-terminal position, the same adsorption mechanism might operate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adsorption of Anaphylatoxins and Platelet-Specific Proteins by Filtration of Platelet Concentrates with a Polyester Leukocyte Reduction Filter

Anaphylatoxins generated during storage of platelet concentrates (PCs) may potentially have side effects on platelet transfusion. We evaluated the anaphy- latoxin-scavenging abilities of white blood cell reduction filters. Among the commercially available filters for PCs, one made with polyester fiber (PL50) dramatically adsorbed C3a and C4a anaphylatoxins to the respective mean level of 1,721-208 ng/ml and 1,240-141 ng/ml in 3-day-old PCs. C3a and C4a were measured as the native and des Arg form of each complement by radioimmunoassay. C3a and C4a anaphylatoxins in the supernatant plasma fraction from 3-day-old PC again decreased from 1,136 to 114 ng/ml and from 1,086 to 65 ng/ml, respectively. The filter also adsorbed 85% of platelet factor 4 (PF4) and 31% of β-thromboglobulin (β-TG), which had been released from platelets into the plasma during storage. The plasma levels of adhesive proteins such as fibronectin, fibrinogen, and von Willebrand factor, and plasma lactate dehydrogenase activity did not decrease after filtration. Another polyester filter (PL5A), on the other hand, significantly increased C3a and C4a levels with filtration. In addition, there was no PF4 adsorption ability during the filtration. The filters for red cells (RC50, BPF4, and R500A) had no anaphyla- toxin adsorption capabilities. The observed specific adsorption of anaphylatoxins might be attributed to the electrostatic force between the positively charged anaphylatoxins with high pi and the possibly negatively charged filter membranes. Since PF4 and ß-TG have positively charged moieties in the C-terminal position, the same adsorption mechanism might operate. We have obtained a useful scavenging filter for the evaluation of side effects of anaphylatoxins on patients who received old PCs.