Leukocyte reduction in blood component therapy.
OBJECTIVE
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.


METHODS
English-language articles on transfusion medicine.


METHODS
Original reports describing the pathogenesis of leukocyte-induced adverse effects in transfusion recipients and the influence of leukocyte-reduced blood components on these effects.


METHODS
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.


RESULTS
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 transfusion-associated 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 10(7) 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 10(7) 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.
Lane
T A
TA
UCSD School of Medicine, Department of Pathology, La Jolla 92093.
Anderson
K C
KC
Goodnough
L T
LT
Kurtz
S
S
Moroff
G
G
Pisciotto
P T
PT
Sayers
M
M
Silberstein
L E
LE
D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods*; D002469:Cell Separation / Q000379:methods*; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007239:Infections / Q000635:transmission; D007519:Isoantigens / Q000276:immunology; D007962:Leukocytes / Q000276:immunology / Q000382:microbiology
D007519:Isoantigens