title: Nationwide outbreak of red eye syndrome associated with transfusion of leukocyte-reduced red blood cell units.
abstract: 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 No reactions were reported after LeukoNet filters were withdrawn from the market.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.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Alonso-Echanove
authors.forename: Brian D
authors.initials: BD
authors.lastname: Sippy
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Chin
authors.forename: Lisa
authors.initials: L
authors.lastname: Cairns
authors.forename: Rebecca
authors.initials: R
authors.lastname: Haley
authors.forename: Jay S
authors.initials: JS
authors.lastname: Epstein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Richards
authors.forename: Henry
authors.initials: H
authors.lastname: Edelhauser
authors.forename: Katrina
authors.initials: K
authors.lastname: Hedberg
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kuehnert
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: Michele L
authors.initials: ML
authors.lastname: Pearson
mesh_terms: 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