Universal leukoreduction (ULR) involves the removal of WBCs from all cellular blood components. Leukoreduction (LR) has been shown to be beneficial in reducing recurrent febrile nonhemolytic transfusion reactions (FNHTR), human leukocyte antigens alloimmunization, and platelet refractoriness in multitransfused patients and in preventing transmission of leukotropic viruses such as cytomegalovirus (CMV) and Epsteinalovirusnan (EBV). ULR is the only option if these benefits are to be completely passed on to the patient for various reasons like:
PENNY WISE POUND FOOLISH?
The main reason for not implementing ULR appears to be financial. However, the reduction in the duration of hospital stay and morbidity outweighs the cost of using leukoreduced blood products.
For example, transfusion reactions like FNHTR, which can be prevented by LR, may extend the hospital stay for the patient, thus adding to his treatment cost! Furthermore, a simple transfusion reaction like FNHTR may lead to wastage of units. By adopting ULR, the wastage of blood can be brought down.
CAN WE IGNORE TRANSFUSION- TRANSMISSIBLE INFECTIONS WHICH WE ROUTINELY DON'T TEST FOR?
In addition to the recommended indications, LR also helps in reducing transmission of other viruses, which we do not test for as a part of transfusion-transmissible infection screening in blood banks such as CMV and EBV. LR is proven to reduce the transmission of bacterial infections like Yersinia enterocolitica.
Why should we deprive a patient of these benefits?
SELECTIVE LEUKOREDUCTION CAN ONLY BE POSTSTORAGE
We are aware that prestorage WBC filtration is more efficient in preventing the release of cytokines, and selective LR includes poststorage LR, where the release of inflammatory cytokine mediators from the leukocytes during the storage is not prevented. Hence, the true benefit of LR for preventing FNHTR can only be achieved by ULR.[1,2,3]
SHOULD WE IGNORE OTHER CLASSES OF EVIDENCE?
LR offers many benefits other than the ones mentioned above. a large study by Blumberg et al, a substantial decrease occurred in the rates of transfusion-related acute lung injury from 2.8 cases/100,000 components before to 0.48 after ULR. Likewise, Transfusion associated circulatory overload came down from 7.4 to 3.8 cases/100,000 and febrile reactions from 11.4 to 7.4 cases per 10,000 after the introduction of ULR.[4]
Following the implementation of ULR, the French hemovigilance network showed a significant reduction in bacterial sepsis and FNHTR (3.8% vs. 1.7% and 32.9% vs. 25.8%, respectively).[5]
A national ULR program is potentially associated with decreased mortality as well as decreased fever episodes and antibiotic use after red blood cell transfusion in high-risk patients.[6]
LEUKOREDUCTION BENEFITS ALL CATEGORIES OF PATIENTS
From oncology to cardiac surgery to intensive care units, LR benefits all categories of patients.
Realizing these benefits, ULR has been adopted by developed nations such as Canada, Britain, France, and Germany.[7] As of 2008, most developed countries have adopted ULR, except the United States of America.
Hence, in this era, when people want to drink safe filtered water, should we not use safe leukoreduced blood components?
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Heddle NM, Blajchman MA, Meyer RM, Lipton JH, Walker IR, Sher GD, et al A randomized controlled trial comparing the frequency of acute reactions to plasma-removed platelets and prestorage WBC-reduced platelets Transfusion. 2002;42:556–66
2. Muylle L, Joos M, Wouters E, De Bock R, Peetermans ME. Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL-6) levels in the plasma of stored platelet concentrates: Relationship between TNF alpha and IL-6 levels and febrile transfusion reactions Transfusion. 1993;33:195–9
3. Rebulla P, Dzik WH. Multicenter evaluation of methods for counting residual white cells in leukocyte-depleted red blood cells. The Biomedical Excellence for Safer Transfusion (BEST) Working Party of the International Society of Blood Transfusion Vox Sang. 1994;66:25–32
4. Blumberg N, Heal JM, Gettings KF, Phipps RP, Masel D, Refaai MA, et al An association between decreased cardiopulmonary complications (transfusion-related acute lung injury and transfusion-associated circulatory overload) and implementation of universal leukoreduction of blood transfusions Transfusion. 2010;50:2738–44
5. Andreu G, Morel P, Forestier F, Debeir J, Rebibo D, Janvier G, et al Hemovigilance network in France: Organization and analysis of immediate transfusion incident reports from 1994 to 1998 Transfusion. 2002;42:1356–64
6. Hébert PC, Fergusson D, Blajchman MA, Wells GA, Kmetic A, Coyle D, et al Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions JAMA. 2003;289:1941–9
7. Bassuni WY, Blajchman MA, Al-Moshary MA. Why implement universal leukoreduction? Hematol Oncol Stem Cell Ther. 2008;1:106–23
