Leukoreduction before red blood cell transfusion has no impact on mortality in trauma patients.
BACKGROUND
Studies suggest that leukocytes in donated blood increase mortality and length of hospital stay (LOS) after transfusion. These studies included few trauma patients, however. Many institutions now mandate leukoreduction (LR) of transfusion products, which increases costs by approximately $30/unit. The purpose of this study was to examine the effect of LR on mortality and LOS in trauma patients.


METHODS
A retrospective before-and-after cohort study was conducted at a level one urban trauma center. LR of all transfusion products commenced in January 2002. All patients treated within the intervention period (March 2002 through January 2004) received LR products. Those transfused during March 2000 through January 2002 served as controls. The trauma registry was queried for patients >or=18 years who survived >or=2 days and received >or=2 units of blood. Mortality and LOS were determined for each group. Subset analysis was performed on patients receiving 2-6 transfusions and those receiving massive transfusion (>or=6 units). Mortality and LOS for control and intervention subsets were compared. Means were compared using Student's t-test, proportions using chi(2) (significance P <or= 0.05).


RESULTS
There were 439 patients in the control group and 240 patients in the intervention group. Groups were similar in age and mechanism of injury. There was no difference in mortality overall (P = 0.68) or after massive transfusion (P = 0.14). There was no difference in LOS overall (control, 12 +/- 17 days; intervention, 12 +/- 13.8 days, P = 0.46) or after subset analysis.


CONCLUSIONS
In those transfused patients who survive 48 h post-injury, LR of blood transfusion products has no beneficial impact on patient survival or hospital LOS. The associated costs of universal LR are not justified.
Phelan
Herb A
HA
Department of Surgery, Division of Trauma/Critical Care, University of South Alabama Medical Center, Mobile, Alabama, USA. hphela@yahoo.com <hphela@yahoo.com>
Sperry
Jason L
JL
Friese
Randall S
RS
D000328:Adult; D000368:Aged; D001771:Blood Banks / Q000191:economics; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality* / Q000628:therapy*