Leukoreduction

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Leukoreduction is the removal of white blood cells (or leukocytes) from the blood or blood components supplied for blood transfusion. After the removal of the leukocytes, the blood product is said to be leukoreduced.

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Benefits and costs

It is theorized that transfusions that contain white blood cells may cause adverse effects through multiple mechanisms. White blood cells may themselves harbor infectious disease and some pathogens will be more concentrated in white blood cells than the rest of the blood product. [1] It is also theorized that the donor white blood cells may suppress the recipient's immune system by interacting with it.[ citation needed ]

An April 2007 meta-analysis by Dr. Neil Blumberg and others and covering 3093 patients who received leukoreduced blood was published in the scientific journal Transfusion. According to the meta-analysis, use of leukoreduced blood reduced the frequency of post-transfusion infection by 50%. [2] In a previous study, Blumberg and others reported that a change to universal use of leukoreduced blood at Strong Memorial Hospital at University of Rochester reduced post-transfusion infection by 33-45%. [3]

However, other scientific studies question the effectiveness of leukoreduction. A March 2007 study by researchers at University of South Alabama Medical Center found no reduction of mortality or length of hospital stay in 439 trauma patients who received leukoreduced transfusions compared to 240 patients who did not. [4] University of Washington researchers reported in October 2006 that a study of 286 transfused injury patients showed no reduction in mortality or length of stay, although a 16% reduction in rate of infection was shown with marginal statistical significance. [5]

Leukoreduction has the inadvertent effect of removing approximately 10% of red blood cells from a processed unit of Red Blood Cells. [6] Because blood from persons who possess the sickle cell mutation is difficult to filter, leukoreduction is often not performed on donors who may have the sickle cell gene, which is most common in people of African descent. [6]

Dr. Blumberg, the lead author of the meta-analysis covering 3093 patients, stated in the press that the cost savings due to universal leukoreduction exceeds the cost of performing the leukoreduction. [7] [ medical citation needed ] The cost of leukoreduction is an increase of approximately US$30 per unit of blood product. [4] [ medical citation needed ]

History of availability

Universal leukoreduction is currently not practiced in all countries.[ citation needed ]

As of 2008, most developed nations have adopted universal leukoreduction of transfusions (defined as the routine application of this blood-processing step to all units of whole blood, red blood cells, and platelets prior to storage) with the notable exception of the United States. [8] Canada, Britain and France adopted universal leukoreduction in the late 1990s. Germany adopted it in 2001. [9] Leukoreduced products are commonly available in the United States and some hospitals use only leukoreduced blood while others only use leukoreduced products in certain patient populations. For example, Strong Memorial Hospital began universal use of leukoreduced blood in July 2000; [7] University of South Alabama Medical Center began use in January 2002. [4] Woodlands Medical Centre is beginning a randomised controlled trial to look into the benefits of transfusing leukoreduced whole blood for the ICCU patients.

See also

Related Research Articles

<span class="mw-page-title-main">Blood type</span> Classification of blood based on antibodies and antigens on red blood cell surfaces

A blood type is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens can stem from one allele and collectively form a blood group system.

<span class="mw-page-title-main">Blood transfusion</span> Intravenous transference of blood products

Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, platelets, and other clotting factors.

A blood bank is a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a department of a hospital usually within a Clinical Pathology laboratory where the storage of blood product occurs and where pre-transfusion and Blood compatibility testing is performed. However, it sometimes refers to a collection center, and some hospitals also perform collection. Blood banking includes tasks related to blood collection, processing, testing, separation, and storage.

<span class="mw-page-title-main">Blood donation</span> Voluntary blood withdrawal for use by another person via transfusion

A blood donation occurs when a person voluntarily has blood drawn and used for transfusions and/or made into biopharmaceutical medications by a process called fractionation. Donation may be of whole blood, or of specific components directly (apheresis). Blood banks often participate in the collection process as well as the procedures that follow it.

<span class="mw-page-title-main">Apheresis</span> Medical techniques to separate one or more components of blood

Apheresis is a medical technology in which the blood of a person is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation. It is thus an extracorporeal therapy.

<span class="mw-page-title-main">Plasmapheresis</span> Removal, treatment and return of blood plasma

Plasmapheresis is the removal, treatment, and return or exchange of blood plasma or components thereof from and to the blood circulation. It is thus an extracorporeal therapy, a medical procedure performed outside the body.

<span class="mw-page-title-main">Plateletpheresis</span> Method of collecting platelets from blood

Plateletpheresis is the process of collecting thrombocytes, more commonly called platelets, a component of blood involved in blood clotting. The term specifically refers to the method of collecting the platelets, which is performed by a device used in blood donation that separates the platelets and returns other portions of the blood to the donor. Platelet transfusion can be a life-saving procedure in preventing or treating serious complications from bleeding and hemorrhage in patients who have disorders manifesting as thrombocytopenia or platelet dysfunction. This process may also be used therapeutically to treat disorders resulting in extraordinarily high platelet counts such as essential thrombocytosis.

Leukapheresis is a laboratory procedure in which white blood cells are separated from a sample of blood. It is a specific type of apheresis, the more general term for separating out one particular constituent of blood and returning the remainder to the circulation.

<span class="mw-page-title-main">Transfusion-related acute lung injury</span> Medical condition

Transfusion-related acute lung injury (TRALI) is the serious complication of transfusion of blood products that is characterized by the rapid onset of excess fluid in the lungs. It can cause dangerous drops in the supply of oxygen to body tissues. Although changes in transfusion practices have reduced the incidence of TRALI, it was the leading cause of transfusion-related deaths in the United States from fiscal year 2008 through fiscal year 2012.

<span class="mw-page-title-main">Platelet transfusion</span> Treatment for bleeding irregularities

Platelet transfusion, also known as platelet concentrate, is used to prevent or treat bleeding in people with either a low platelet count or poor platelet function. Often this occurs in people receiving cancer chemotherapy. Preventive transfusion is often done in those with platelet levels of less than 10 x 109/L. In those who are bleeding transfusion is usually carried out at less than 50 x 109/L. Blood group matching (ABO, RhD) is typically recommended before platelets are given. Unmatched platelets, however, are often used due to the unavailability of matched platelets. They are given by injection into a vein.

An exchange transfusion is a blood transfusion in which the patient's blood or components of it are exchanged with other blood or blood products. The patient's blood is removed and replaced by donated blood or blood components. This exchange transfusion can be performed manually or using a machine (apheresis).

Erythrocytapheresis is an apheresis procedure by which erythrocytes are separated from whole blood. It is an extracorporeal blood separation method whereby whole blood is extracted from a donor or patient, the red blood cells are separated, and the remaining blood is returned to circulation.

<span class="mw-page-title-main">Packed red blood cells</span> Red blood cells separated for blood transfusion

Packed red blood cells, also known as packed cells, are red blood cells that have been separated for blood transfusion. The packed cells are typically used in anemia that is either causing symptoms or when the hemoglobin is less than usually 70–80 g/L. In adults, one unit brings up hemoglobin levels by about 10 g/L. Repeated transfusions may be required in people receiving cancer chemotherapy or who have hemoglobin disorders. Cross-matching is typically required before the blood is given. It is given by injection into a vein.

Patient Blood Management (PBM) is a set of medical practices designed to optimise the care of patients who might need a blood transfusion. Patient blood management programs use an organized framework to improve blood health, thus increasing patient safety and quality of life, reducing costs, and improving clinical outcomes. Some strategies to accomplish this include ensuring that anemia is treated prior to a surgical operation, using surgical techniques that limit blood loss, and returning blood lost during surgery to the patient via intraoperative blood salvage.

Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reaction. It is a benign occurrence with symptoms that include fever but not directly related with hemolysis. It is caused by cytokine release from leukocytes within the donor product as a consequence of white blood cell breakdown .These inflammatory mediators accumulate during the storage of the donated blood, and so the frequency of this reaction increases with the storage length of donated blood. This is in contrast to transfusion-associated acute lung injury, in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage.

Plasma frozen within 24 hours after phlebotomy, commonly called FP24, PF‑24, or similar names, is a frozen human blood plasma product used in transfusion medicine. It differs from fresh-frozen plasma (FFP) in that it is frozen within 24 hours of blood collection, whereas FFP is frozen within 8 hours. The phrase "FFP" is sometimes used to refer to any frozen blood plasma product intended for transfusion.

<span class="mw-page-title-main">RHD (gene)</span> Protein-coding gene in the species Homo sapiens

Rh blood group, D antigen also known as Rh polypeptide 1 (RhPI) or cluster of differentiation 240D (CD240D) is a protein that in humans is encoded by the RHD gene.

Serious Hazards of Transfusion (SHOT) is the United Kingdom's haemovigilance scheme.

An allergic transfusion reaction is when a blood transfusion results in allergic reaction. It is among the most common transfusion reactions to occur. Reported rates depend on the degree of active surveillance versus passing reporting to the blood bank. Overall, they are estimated to complicate up to 3% of all transfusions. The incidence of allergic transfusion reactions is associated with the amount of plasma in the product. More than 90% of these reactions occur during transfusion.

A granulocyte transfusion is a medical procedure in which granulocytes are infused into a person's blood. Granulocyte transfusions were historically used to prevent and treat infections in people with neutropenia, but the practice declined in popularity in the 1980s. Interest in the procedure increased in the 1990s due to the development of more effective methods for harvesting granulocytes and a growing population of people with severe neutropenia from chemotherapy. However, the treatment's efficacy remains poorly understood and its use is controversial.

References

  1. ↑ "Creutzfeldt-Jakob disease - Prevention". nhs.uk. 2017-10-23. Retrieved 2023-06-22.
  2. ↑ Blumberg N, Zhao H, Wang H, Messing S, Heal JM, Lyman GH (April 2007). "The intention-to-treat principle in clinical trials and meta-analyses of leukoreduced blood transfusions in surgical patients". Transfusion. 47 (4): 573–81. doi:10.1111/j.1537-2995.2007.01158.x. PMID   17381614. S2CID   204537.
  3. ↑ Blumberg N, Fine L, Gettings KF, Heal JM (October 2005). "Decreased sepsis related to indwelling venous access devices coincident with implementation of universal leukoreduction of blood transfusions". Transfusion. 45 (10): 1632–9. doi:10.1111/j.1537-2995.2005.00565.x. PMID   16181215. S2CID   23584867.
  4. 1 2 3 Phelan HA, Sperry JL, Friese RS (March 2007). "Leukoreduction before red blood cell transfusion has no impact on mortality in trauma patients". Journal of Surgical Research. 138 (1): 32–6. doi:10.1016/j.jss.2006.07.048. PMID   17161430.
  5. ↑ Nathens AB, Nester TA, Rubenfeld GD, Nirula R, Gernsheimer TB (October 2006). "The effects of leukoreduced blood transfusion on infection risk following injury: a randomized controlled trial". Shock. 26 (4): 342–7. doi: 10.1097/01.shk.0000228171.32587.a1 . PMID   16980879. S2CID   24870961.
  6. 1 2 "Donated Blood Needs Filtering, Panel Advises". New York Times. Associated Press. January 28, 2001. Retrieved 2007-04-07.
  7. 1 2 University of Rochester Medical Center (April 5, 2007). "Transfusion Expert Urges Wider Use Of Filtered Blood". Science Daily. Retrieved 7 April 2007.
  8. ↑ Bassuni et al. Why implement universal leukoreduction? Hematol Oncol Stem Cell Ther 2008;1:106-123 "Hematology/Oncology and Stem Cell Therapy"
  9. ↑ "Bekanntmachung des Paul-Ehrlich-Instituts über die Ergebnisse des Stufenplanverfahrens zur Einführung der Leukozytendepletion von zellulären Blutprodukten zur Transfusion (vom 18. August 2000)". Archived from the original on 2014-08-10. Retrieved 2013-09-03.
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