Nonleukoreduced Blood Research Articles

Transfusion of leukoreduced red blood cells may decrease postoperative infections: two meta-analyses of randomized controlled trials.

To evaluate the efficacy and effectiveness of red blood cell leukoreduction in reducing postoperative infection, mortality and cancer recurrence, two meta-analyses of randomized controlled trials (RCTs) were conducted. A systematic search of the scientific literature was conducted. The pooled relative risk ratio (RR) of developing an adverse postoperative outcome with either leukoreduced or non-leukoreduced blood was calculated using a random effects model. To better estimate the efficacy of leukoreduction, a second analysis of transfused patients only was conducted. Ten RCTs met inclusion criteria and eight provided separate data for patients randomized and transfused. The mean percentage of patients randomized but not transfused was 34%. For postoperative infection, the overall pooled RR was 0.76 [(95% confidence interval (CI): 0.54-1.08] for the "all patients randomized" analysis. For the "only patients transfused" analysis, the pooled RR became clinically and statistically significant (RR = 0.60 (95% CI: 0.38-0.93). For mortality, the pooled RR for the "all patients randomized" analysis was 0.71 (95% CI: 0.45-1.13) and 0.61 (95% CI: 0.36-1.04) for the "only patients transfused" analysis. When analyzing either all patients randomized or all patients transfused, there was no statistically significant difference in cancer recurrence rates (one study only). We demonstrated that patients who were transfused leukoreduced red blood cells might benefit from a decrease in postoperative infections. A decrease in mortality may have been realized if more patients had been enrolled in the various randomized trials. Including all patients randomized, regardless of whether or not they were actually transfused diluted the observed clinical benefit of leukoreduction.

Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness

AbstractRandomized controlled trials have shown a reduction in platelet alloimmunization and refractoriness in patients with acute leukemia (AL) with the use of poststorage leukoreduction of blood products. Universal prestorage leukoreduction (ULR) of red cell and platelet products has been performed in Canada since August 1999. We conducted a retrospective analysis of 13 902 platelet transfusions in 617 patients undergoing chemotherapy (CT) for AL or stem cell transplantation (SCT) before (n = 315) and after (n = 302) the introduction of ULR. Alloimmunization was significantly reduced (19% to 7%, P < .001) in the post-ULR group. Alloimmune platelet refractoriness was similarly reduced (14% to 4%, P < .001). Fewer patients in the post-ULR group received HLA-matched platelets (14% vs 5%, P < .001). Alloimmunization and alloimmune refractoriness in the 318 patients who were previously pregnant and/or transfused were also reduced after ULR (P = .023 and P = .005, respectively). In a Cox regression model, the 3 independent factors that predicted for alloimmune refractoriness were nonleukoreduced blood products (relative risk [RR], 2.2 [95% CI, 1.2-4.3]), a history of pregnancy and/or transfusion (RR, 2.3 [95% CI, 1.3-4.2]), and receipt of 13 or more platelet transfusions (RR, 6.0 [95% CI, 2.4-15.3]). In conclusion, ULR reduces alloimmunization, refractoriness, and requirements for HLA-matched platelets when applied as routine transfusion practice to patients receiving CT or SCT.

The Cost Consequences of Universal Leukoreduction

SUMMARY Purpose: To review the published literature on cost analysis of the use of leukoreduced allogeneic blood components or autologous blood for transfusion versus the use of nonleukoreduced blood transfusions and to assess the implications for the universal leukoreduction of blood components. Methods: A total of three retrospective cohort studies, one randomized, controlled trial and one implementation trial are included in the review. In addition, an overview is provided of the medical issues concerning universal leukoreduction and the current controversy surrounding the instituting of such a policy in the United States. Results: All five studies reported overall cost savings with the use of leukoreduced or autologous products compared with the use of unmodified allogeneic blood components. Conclusion: The use of leukoreduced blood components for transfusion provides an overall cost benefit for patients undergoing transfusion for surgery or hematologic malignancy, many of whom would receive nonleukoreduced blood under current recommendations. The savings due to the reduction in morbidity in surgical patients alone could well equal or exceed the added expense of universal leukoreduction.

Universal leukoreduction of cellular blood components in 2001? No.

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