title: Febrile and allergic transfusion reactions after the transfusion of white cell-poor platelet preparations.
abstract: BACKGROUND
  Nonhemolytic transfusion reactions (NHTRs) frequently occur after platelet transfusions. White cell (WBC)-derived inflammatory cytokines can cause these reactions, but they are rarely found in WBC-poor platelet preparations. Transfusion reactions were investigated with regard to the residual WBC content in the stored platelet concentrate in two consecutive study periods.
  
  
  METHODS
  In the first study period, platelet concentrates were WBC-reduced by bedside filtration. In the second period, all platelet concentrates were filtered before storage. Recipients who experienced transfusion reactions were examined with regard to their main clinical symptoms during and after transfusion. In the supernatant of the involved platelet concentrates, concentrations of interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor (TNF)alpha, macrophage inflammatory protein 1alpha, and RANTES were analyzed.
  
  
  RESULTS
  The incidence of transfusion reactions remained steady when the transfusion regimen was changed from bedside filtration to prestorage WBC filtration (1.63% and 1.56%; p = 0.84). In both periods, NHTRs were predominantly of allergic origin. Inflammatory mediators IL-1beta, IL-6, IL-8, and TNFalpha were detectable in only a minority of platelet components involved in NHTRs. Platelet concentrates involved in allergic reactions contained high concentrations of RANTES (668 +/- 223 ng/mL).
  
  
  CONCLUSIONS
  Prestorage WBC filtration did not reduce the incidence of these reactions, and inflammatory cytokines were of minor relevance. The proinflammatory platelet-derived chemokine RANTES, which accumulates even in WBC-reduced platelet concentrates, was associated with allergic transfusion reactions. Platelet-derived mediators may be a key to understanding NHTRs.
authors.affiliation: Institute of Immunology and Transfusion Medicine, University of Lübeck School of Medicine, Germany. h.klueter@blutspende.de
authors.forename: H
authors.initials: H
authors.lastname: Klüter
authors.forename: S
authors.initials: S
authors.lastname: Bubel
authors.forename: H
authors.initials: H
authors.lastname: Kirchner
authors.forename: D
authors.initials: D
authors.lastname: Wilhelm
mesh_terms: D000961:Antilymphocyte Serum / Q000097:blood; D001781:Blood Component Removal; D001792:Blood Platelets / Q000737:chemistry; D001793:Blood Preservation; D018925:Chemokines / Q000097:blood; D016207:Cytokines / Q000097:blood; D005334:Fever / Q000209:etiology*; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D007937:Leukapheresis; D017713:Platelet Transfusion / Q000009:adverse effects*; D013997:Time Factors; D065227:Transfusion Reaction
chemical_list: D000961:Antilymphocyte Serum; D018925:Chemokines; D016207:Cytokines