The use of leukoreduced red blood cell products is associated with fewer infectious complications in trauma patients.
BACKGROUND
Clinical studies suggest that leukocytes in banked blood may increase infectious complications after transfusion. However, these investigations included few injured patients. Therefore, the effect of the use of leukoreduced red blood cell (RBC) products in this patient population is unknown. In addition, large numbers of RBC transfusions are frequently required in the treatment of patients with hemorrhagic shock, which may have a more profound effect on infectious risk. The purpose of this study was to determine the effect of prestorage leukoreduction on infectious complications in injured patients.


METHODS
A retrospective before-and-after cohort study was conducted at an urban level 1 trauma center. A policy of using leukoreduced RBC products commenced in January 2002. Patients treated from March 2002 through December 2003 received leukoreduced RBC products. Those transfused from March 2000 through December 2001 served as controls. Inclusion criteria were age >or=18 years, survival >or=2 days after admission, and transfusion of >or=2 U RBCs within 24 hours of admission. There were 240 patients in the leukoreduction group, and 438 patients in the control group. Multivariate logistic regression controlling for age, sex, injury severity, and number of transfusions was used to determine if leukoreduction status was an independent predictor of infectious complications. Subset analysis was performed on patients receiving massive transfusion (ie, >6 units in 24 hours; n = 168).


RESULTS
Patient demographics and injury severity characteristics were similar during both treatment periods. Overall, those patients receiving leukoreduced RBC products had a 45% reduction in nosocomial pneumonia (odds ratio [OR] .55; 95% confidence interval [CI] .33-.91) and a significant reduction in the development of any type of infection (OR .48; 95% CI .31-.73). In the massive-transfusion subset, the OR for development of any infection was .33 (95% CI, .15-.73), and the OR for the development of pneumonia was .29 (95% CI, .11.76) in those patients receiving leukoreduced RBC products. There were no differences in mortality within the overall- or massive-transfusion subset analyses.


CONCLUSIONS
Prestorage leukoreduction is associated with a reduction of infectious complications in injured patients. Furthermore, this protective effect appears more pronounced in patients receiving massive transfusion (>6 U packed RBCs).
Division of Burn, Trauma, Critical Care, Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. randall.friese@utsouthwestern.edu
Randall S
RS
Friese
Jason L
JL
Sperry
Herb A
HA
Phelan
Larry M
LM
Gentilello
D000328:Adult; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications*