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Leukocyte Reduction in Blood Component Therapy
- Thomas A. Lane, MD;
- Kenneth C. Anderson, MD;
- Lawrence T. Goodnough, MD;
- Sanford Kurtz, MD;
- Gary Moroff, PhD;
- Patricia T. Pisciotto, MD;
- Merlin Sayers, MD, PhD; and
- Leslie E. Silberstein, MD
Abstract
▪ Purpose: To review methods of preventing or minimizing the adverse effects associated with the transfusion of passenger leukocytes present in cellular blood components and to define groups of patients who are at risk for adverse effects.
▪ Data Sources: English-language articles on transfusion medicine.
▪ Study Selection: Original reports describing the pathogenesis of leukocyte-induced adverse effects in transfusion recipients and the influence of leukocytereduced blood components on these effects.
▪ Data Extraction: Evaluation of the diagnosis, transfusion history, and treatment of the study patients; the methods and results of leukocyte reduction; and specific outcomes, including development of alloimmunization to leukocytes, febrile reactions to transfusion, and platelet refractoriness.
▪ Data Synthesis: Passenger leukocytes are the chief cause of alloimmunization to human leukocyte antigen (HLA) and leukocyte-specific antigens in transfusion recipients. Alloimmunization may result in febrile transfusion reactions, platelet refractoriness, and acute lung injury. Leukocytes are also the vector for transfusionassociated cytomegalovirus infection. Technologic advances in the leukocyte reduction of cellular blood components have made it possible to reduce the number of leukocytes to fewer than 107 per transfusion. Findings suggest that the use of leukocyte-reduced cellular blood components may minimize or prevent recurrent febrile reactions and alloimmunization to leukocyte antigens. Cytomegalovirus may not be transmitted by blood components containing fewer than 107 leukocytes.
▪ Conclusions: Leukocyte reduction in red blood cell and platelet transfusions using third-generation filters is indicated for selected patients who are likely to receive long-term transfusion support, to prevent recurrent febrile reactions and to prevent or delay alloimmunization to leukocyte antigens. Leukocyte-depleted transfusions may also be indicated to delay or prevent refractoriness to platelet transfusion.
Article and Author Information
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From the University of California, San Diego, School of Medicine, La Jolla, California; Dana-Farber Institute, Boston, Massachusetts; University Hospitals, Cleveland, Ohio; Lahey Clinic, Burlington, Massachusetts; the American Red Cross, Rockville, Maryland; University of Connecticut Health Center, Farmington, Connecticut; Puget Sound Blood Center and Program, Seattle, Washington; and the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. For current author addresses, see end of text.
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Grant Support: In part by the American Association of Blood Banks.
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Requests for Reprints: Thomas A. Lane, MD, UCSD School of Medicine, Department of Pathology 0612, 9500 Gilman Drive, La Jolla, CA 92093.
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Current Author Addresses: Dr. Lane: Department of Pathology 0612, UCSD School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093.
Dr. Anderson: Dana-Farber Institute, 44 Binney Street, Boston, MA 02115.
Dr. Goodnough: Department of Medicine, University Hospitals, 2074 Abigton Road, Cleveland, OH 44106.
Dr. Kurtz: Lahey Clinic, 41 Mall Road, Box 541, Burlington, MA 01805.
Dr. Moroff: American Red Cross, Jerome Holland Laboratory, 15601 Crabb's Branch Way, Rockville, MD 20855.
Dr. Pisciotto: University of Connecticut Health Center, Department of Laboratory Medicine, C2058, Farmington, CT 06030.
Dr. Sayers: Puget Sound Blood Center and Program, 921 Terry Avenue, Seattle, WA 98104-1256.
Dr. Silberstein: Hospital of the University of Pennsylvania, Blood Bank, 3400 Spruce Street, 6-60, Founders Pavilion, Philadelphia, PA 19104-4283.
- ©1992 American College of Physicians
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