A prospective, randomized clinical trial of universal WBC reduction.
BACKGROUND
Recipient exposure to allogeneic donor WBCs results in transfusion complications for selected populations of recipients. Whether or not WBC reduction should be universally applied is highly controversial.


METHODS
In a general hospital, a randomized, controlled clinical trial of conversion to universal WBC reduction was conducted. Patients (11%) with established medical indications for WBC-reduced blood were not eligible. All other patients who required transfusion were assigned at random to receive either unmodified blood components or stored WBC-reduced RBCs and platelets. Analysis for each patient was restricted to the first hospitalization.


RESULTS
All eligible patients (n = 2780) were enrolled. Three specified primary outcome measures were not different between the two groups: 1) in-hospital mortality (8.5% control; 9.0% WBC-reduced; OR, 0.94 [95% CI, 0.72-1.22]; p = 0.64); 2) hospital length of stay (LOS) after transfusion (median number of days, 6.4 for control and 6.3 for WBC-reduced; p = 0.21); and 3) total hospital costs (median, $19,500 for control and $19,200 for WBC-reduced, p = 0.24). Secondary outcomes (intensive care LOS, postoperative LOS, antibiotic usage, and readmission rate) were not different between the two groups. Subgroup analysis based on patient age, sex, amount of blood transfused, or category of surgical procedure showed no effect of WBC reduction. Patients who received WBC-reduced blood had a lower incidence of febrile reactions (p = 0.06).


CONCLUSIONS
A beneficial effect of conversion from selective to universal WBC reduction was not demonstrated.
Dzik
W H
WH
Blood Transfusion Service, Massachusetts General Hospital, Boston 02114, USA. sdzik@partners.org
Anderson
J K
JK
O'Neill
E M
EM
Assmann
S F
SF
Kalish
L A
LA
Stowell
C P
CP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000592:standards; D001803:Blood Transfusion / Q000191:economics / Q000379:methods* / Q000592:standards; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012308:Risk Management; D065227:Transfusion Reaction
D000900:Anti-Bacterial Agents