title: Effects of universal vs bedside leukoreductions on the alloimmunization to platelets and the platelet transfusion refractoriness.
abstract: BACKGROUND
  Multiple platelet exposure induces anti-HLA and/or anti-HPA antibody production, which may cause platelet transfusion refractoriness (PTR). In Japan, the universal pre-storage leukocyte reduction (ULR) was fully implemented since 2006, but prior to ULR, in our institution, leukocyte reduction filters were routinely used at the bedside (bedside leukoreduction, BSLR) for all onco-hematological patients receiving multiple platelet transfusions.
  
  
  OBJECTIVE
  We retrospectively compared patients receiving platelet transfusions in the era of ULR with those of BSLR era.
  
  
  METHODS
  Patients of the BSLR group (409 cases) and the ULR group (586 cases) were compared in terms of alloimmunization and immunological PTR. The clinico-pathological features, including gender, history of pregnancy, number of exposed transfusion donors, periods of transfusion, and prior stem cell transplantation were compared, and the risk factors of alloimmunization were determined.
  
  
  RESULTS
  The antibody detection rate was significantly higher in the ULR compared to BSLR group (8.7% vs. 5.4%), as well as the immunological PTR rate (7.3% vs. 3.2%). By the multivariate analysis, female gender and the number of platelet donor exposure, but not universal leukoreduction or transfusion period, were found to be the risk factors strongly associated with alloantibody formation.
  
  
  CONCLUSIONS
  Although ULR may be superior to BSLR in terms of preventing non-hemolytic transfusion reactions, BSLR was found to be as effective as ULR in terms of preventing platelet alloimmunization and refractoriness. Thus, BSLR should be actively indicated as a realistic alternative in developing countries, before the universal leukoreduction is fully implemented.
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mishima
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: tsuno-tky@umin.net.
authors.forename: Nelson H
authors.initials: NH
authors.lastname: Tsuno
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Matsuhashi
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Tetsuichi
authors.initials: T
authors.lastname: Yoshizato
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Hematology & Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Hematology & Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Watanabe-Okochi
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nagura
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Sone
authors.affiliation: Department of Hematology & Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
authors.affiliation: Department of Transfusion Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okazaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D007937:Leukapheresis; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D019095:Point-of-Care Systems; D011247:Pregnancy; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
chemical_list: D007518:Isoantibodies
keywords: Human leukocyte antigens; Human platelet antigens; Platelet transfusion refractoriness