Leukoreduction
Encyclopedia
Leukoreduction is the removal of white blood cell
s (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.
the recipient's immune system by interacting with it.
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%. 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%.
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. 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.
Leukoreduction has the inadvertent effect of removing approximately 10% of red blood cells from a processed unit of Red Blood Cells. 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.
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. The cost of leukoreduction is an increase of approximately US$30 per unit of blood product.
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. Canada, Britain and France
adopted universal leukoreduction in the late 1990s. 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; University of South Alabama Medical Center began use in January 2002.
Woodlands Medical Centre is beginning a randomised controlled trial to look into the benefits of transfusing leukoreduced whole blood for the ICCU patients.
White blood cell
White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
s (or leukocytes) from the blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
or blood components supplied for blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
. After the removal of the leukocytes, the blood product is said to be leukoreduced.
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. It is also theorized that the donor white blood cells may suppressImmunosuppression
Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...
the recipient's immune system by interacting with it.
An April 2007 meta-analysis
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
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%. In a previous study, Blumberg and others reported that a change to universal use of leukoreduced blood at Strong Memorial Hospital
Strong Memorial Hospital
Strong Memorial Hospital is a 739-bed medical facility, part of the University of Rochester Medical Center complex , in Rochester, New York. Opened in 1926, is a major provider of both in-patient and out-patient medical services....
at University of Rochester
University of Rochester
The University of Rochester is a private, nonsectarian, research university in Rochester, New York, United States. The university grants undergraduate and graduate degrees, including doctoral and professional degrees. The university has six schools and various interdisciplinary programs.The...
reduced post-transfusion infection by 33-45%.
However, other scientific studies question the effectiveness of leukoreduction. A March 2007 study by researchers at University of South Alabama
University of South Alabama
The University of South Alabama is a public, doctoral-level university in Mobile, Alabama, USA. It was created by the Alabama Legislature in 1963, and replaced existing extension programs operated in Mobile by the University of Alabama. No other areas of the state were willing to support such a...
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. University of Washington
University of Washington
University of Washington is a public research university, founded in 1861 in Seattle, Washington, United States. The UW is the largest university in the Northwest and the oldest public university on the West Coast. The university has three campuses, with its largest campus in the University...
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.
Leukoreduction has the inadvertent effect of removing approximately 10% of red blood cells from a processed unit of Red Blood Cells. 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.
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. The cost of leukoreduction is an increase of approximately US$30 per unit of blood product.
History of availability
Universal leukoreduction is currently not practiced in all countries.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. Canada, Britain and France
adopted universal leukoreduction in the late 1990s. 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
Strong Memorial Hospital
Strong Memorial Hospital is a 739-bed medical facility, part of the University of Rochester Medical Center complex , in Rochester, New York. Opened in 1926, is a major provider of both in-patient and out-patient medical services....
began universal use of leukoreduced blood in July 2000; University of South Alabama Medical Center began use in January 2002.
Woodlands Medical Centre is beginning a randomised controlled trial to look into the benefits of transfusing leukoreduced whole blood for the ICCU patients.