Pros and Cons of Different Methods of Leucoreduction and Its Scope of Implementation in the Cost Constrained Settings
Keywords:
leucoreduction, leucofilters, NHFTRs, apheresis, alloimmunisation
Abstract
Half a century ago, most of the blood transfused was whole blood. However, since the 1960s, whole blood has been separated into its various components such as RBCs, platelets and plasma. Rapidly growing size of patients in our country requiring multiple transfusion of blood and components pose a great challenge to transfusion services to provide them red cell and platelet antigen matched products in alloimmunized subjects. However, it has been shown that the removal of leucocytes from various blood products can minimize the risks[1–5] associated with these , which are: Nonhemolytic febrile transfusion reactions, Human leukocyte antigen (HLA) alloimmunization , Platelet refractoriness observed in multi-transfused patients and Transmission of leucotropic viruses such as EBV and CMV. Thus removal of leucocytes below a certain threshold, ≤ 5 × 106 in a blood component certainly helps in prevention of associated risks in these patients. Currently, the best Leucoreduction can be achieved with the help of 3rd generation leucofilters, both in laboratory and patient bed side and apheresis devices.We did a 6 month comparision study of transfusing leucodepleted RCC (Red Cell Concentrate) in Thalassaemia patients prepared by both the methods of leucodepletion ( manual buffy coat removal and leucofiltration) in P.D.U. Medical College and Hospital, Rajkot ,Gujarat ( India) and assesed the effectiveness of both in preventing NHFTRs in multiply transfused patients ,especially in cost contrained settings.Although the terms, leucoreduction and leucodepletion are used interchangeably in literature, Leucoreduction technically implies removal of leukocytes by gross removal method, whereas, Leucodepletion connotes removal of leukocytes with the help of certain specific filters or devices.References
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2. Sniecinski I, O' Donnel MR, Nowicki B, Hill LR. Prevention of refractoriness and HLA-alloimmunization using filtered blood products. Blood. 1988;71:1402–7.
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8. Laforet M, Isola H, Cazenave JP. Leucodepletion of platelet concentrates and plasma collected with haemonetics MCS + apheresis system. Experience of EFS- Alsace. Transfus Apheresis Sci. 2002;25:55–9.
9.Dzik S. Leukodepletion blood filters: Filter design and mechanisms of leukocyte removal. Transfusion Med Rev. 1993;7:65–77.
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11. Muylle L, Joos M, Wouters E, De Bock R, Peetermans ME. Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL-6) levels in the plasma of stored platelet concentrates: Relationship between TNF alpha and IL-6 levels and febrile transfusion reactions. Transfusion. 1993;33:195–9.
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13.on LM, Wimperis JZ, Williamson P, Copplestone JA, Gooi HC, Morgenstern GR, et al. Besides filtration of blood products in the prevention of HLA alloimmunization-a prospective randomized study. Blood. 1994;83:3028–35.
14.aas K, van Marwijk Kooij M, van Prooijen HC, van Dijk BA, van Putten WL, Claas FH, et al. Leukocyte depletion of random single- donor platelet transfusions does not prevent secondary human leukocyte antigen- alloimmunization and refractoriness: A randomized prospective study. Blood. 1995;85:824–8.
15. Dzik WH, Anderson JK, O'Neill EM, Assmann SF, Kalish LA, Stowell CP. A prospective, randomized clinical trial of universal WBC reduction. Transfusion. 2002;42:1114–22.
16.JC, Pomper GJ, Fisch GS, Champion MH, Snyder EL. Reduction of febrile but not allergic reactions to red cells and platelets following conversion to universal Prestorage leukoreduction. Transfusion. 2004;44:16–24.
17. E, Shirey RS, Thoman SK, Bensen-Kennedy D, Tanz WS, Ness PM. Universal leukoreduction decreases the incidence of febrile nonhemolytic reactions to red cells. Transfusion. 2004;44:25–9.
18.en L, Taaning E, Mynster T, Hvolris J, Drachman O, Nielsen HJ. Bioactive substancse in buffy-coat-derived platelet pools stored in platelet-additive solutions. Br J Haematol. 1998;103:445–8.
19. Blajchman MA. The Clinical Benefit of the Leukoreduction of Blood products. J Trauma. 2006;60:S83–90.
20. Rupankar Sanyal.Advantages of Leukodepleted Concentrated Red Blood Corpuscles (Packed Cell). 2013(Mollison's Blood Transfusion in Clinical Medicine, Rossi's Principles of Transfusion Medicine, Essential Guide to Blood Grouping Geoff Daniels, Imelda Bromilow, AABB, Reports of Australian Blood Bank Services )
2. Sniecinski I, O' Donnel MR, Nowicki B, Hill LR. Prevention of refractoriness and HLA-alloimmunization using filtered blood products. Blood. 1988;71:1402–7.
3. Andreu G, Dewailly J, Leberre C, Quarre MC, Bidet ML, Tardivel R, et al. Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration. Blood. 1988;72:964–69.
4. Yazer MH, Podlosky L, Clarke G, Nahirniak SM. The effect of Prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reaction to platelet concentrates and RBC. Transfusion. 2004;44:10–5.
5. reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusion. The Trial to Reduce Alloimmunization to platelet Study Group. N Engl J Med. 1997;337:1861–9.
6. orst P, Engelfriet CP. Removal of leucocytes from whole blood and erythrocytes suspension by filterations through cotton wool. V, Results after transfusion of, units of filtered erythrocytes. Vox Sang. 1975;29:15–8
7. VM, van Doorn R, Witvliet MD, Claas FH, Brand A, et al. Occurrence of allogenic HLA and non HLA antibodies after transfusions of Prestorage filtered platelets and red blood cells: A Prospective study. Blood. 1995;85:1736–41
8. Laforet M, Isola H, Cazenave JP. Leucodepletion of platelet concentrates and plasma collected with haemonetics MCS + apheresis system. Experience of EFS- Alsace. Transfus Apheresis Sci. 2002;25:55–9.
9.Dzik S. Leukodepletion blood filters: Filter design and mechanisms of leukocyte removal. Transfusion Med Rev. 1993;7:65–77.
10.N M, Blajchman MA, Meyer RM, Lipton JH, Walker IR, Sher GD, et al. A randomized controlled trial comparing the frequency of acute reactions to plasma -removed platelets and Prestorage WBC- reduced platelets. Transfusion. 2002;42:556–66.
11. Muylle L, Joos M, Wouters E, De Bock R, Peetermans ME. Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL-6) levels in the plasma of stored platelet concentrates: Relationship between TNF alpha and IL-6 levels and febrile transfusion reactions. Transfusion. 1993;33:195–9.
12.Rebulla P, Dzik WH. Multicenter evaluation of methods for counting residual white cells in leukocyte-depleted red blood cells. Vox Sanguinis. 1994;66:25–32.
13.on LM, Wimperis JZ, Williamson P, Copplestone JA, Gooi HC, Morgenstern GR, et al. Besides filtration of blood products in the prevention of HLA alloimmunization-a prospective randomized study. Blood. 1994;83:3028–35.
14.aas K, van Marwijk Kooij M, van Prooijen HC, van Dijk BA, van Putten WL, Claas FH, et al. Leukocyte depletion of random single- donor platelet transfusions does not prevent secondary human leukocyte antigen- alloimmunization and refractoriness: A randomized prospective study. Blood. 1995;85:824–8.
15. Dzik WH, Anderson JK, O'Neill EM, Assmann SF, Kalish LA, Stowell CP. A prospective, randomized clinical trial of universal WBC reduction. Transfusion. 2002;42:1114–22.
16.JC, Pomper GJ, Fisch GS, Champion MH, Snyder EL. Reduction of febrile but not allergic reactions to red cells and platelets following conversion to universal Prestorage leukoreduction. Transfusion. 2004;44:16–24.
17. E, Shirey RS, Thoman SK, Bensen-Kennedy D, Tanz WS, Ness PM. Universal leukoreduction decreases the incidence of febrile nonhemolytic reactions to red cells. Transfusion. 2004;44:25–9.
18.en L, Taaning E, Mynster T, Hvolris J, Drachman O, Nielsen HJ. Bioactive substancse in buffy-coat-derived platelet pools stored in platelet-additive solutions. Br J Haematol. 1998;103:445–8.
19. Blajchman MA. The Clinical Benefit of the Leukoreduction of Blood products. J Trauma. 2006;60:S83–90.
20. Rupankar Sanyal.Advantages of Leukodepleted Concentrated Red Blood Corpuscles (Packed Cell). 2013(Mollison's Blood Transfusion in Clinical Medicine, Rossi's Principles of Transfusion Medicine, Essential Guide to Blood Grouping Geoff Daniels, Imelda Bromilow, AABB, Reports of Australian Blood Bank Services )
Published
2016-02-07
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Original Article
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