Nationwide outbreak of red eye syndrome associated with transfusion of leukocyte-reduced red blood cell units.
OBJECTIVE
To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion.


METHODS
We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions.


RESULTS
From January 1, 1997, through January 15, 1998, we identified 159 reactions in 117 patients from 17 states. Reactions were characterized by conjunctival erythema or hemorrhage (in 100% of patients), eye pain (in 62%), photophobia (in 46%), and decreased visual acuity (in 32%). Symptom onset occurred 1-24 hours after initiation of transfusion and resolved within a median of 5 days. Reactions were associated with transfusion sessions that included units of red blood cells filtered with a specific brand of filter, the LeukoNet filter (HemaSure) (odds ratio, 100.4; P<.001). There was a dose-response relationship between the number of LeukoNet-filtered units transfused and the attack rate for reactions, ranging from 0.8% among sessions in which 1 unit was transfused to 27.3% among sessions in which 3 or more units were transfused (P<.001). A similar ocular syndrome was elicited in rabbits injected with cellulose acetate derivatives extracted from unused LeukoNet filters or filter precursors. No reactions were reported after LeukoNet filters were withdrawn from the market.


CONCLUSIONS
This transfusion-associated red eye syndrome was linked to a specific brand of leukocyte-reduction filter and likely resulted from cellulose acetate derivatives leached from the filter membrane.
Alonso-Echanove
Juan
J
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Sippy
Brian D
BD
Chin
Arthur E
AE
Cairns
Lisa
L
Haley
Rebecca
R
Epstein
Jay S
JS
Richards
Michael J
MJ
Edelhauser
Henry
H
Hedberg
Katrina
K
Kuehnert
Matthew J
MJ
Jarvis
William R
WR
Pearson
Michele L
ML
D000818:Animals; D003228:Conjunctiva / Q000473:pathology*; D004196:Disease Outbreaks; D004890:Erythema / Q000473:pathology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005128:Eye Diseases / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005374:Filtration; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D047589:Leukocyte Reduction Procedures; D008824:Michigan / Q000453:epidemiology; D009922:Oregon / Q000453:epidemiology; D010146:Pain; D020795:Photophobia; D011817:Rabbits; D013577:Syndrome; D014792:Visual Acuity; D014861:Washington / Q000453:epidemiology