Guidelines on the clinical use of leucocyte‐depleted blood components

Abstract

Definition: Leucocyte‐depleted blood components must contain < 5 × 106 leucocytes per unit (red cells) or adult therapeutic dose (platelets). Practical aspects: To achieve residual leucocyte counts of < 5 × 106, leucocyte‐depletion should be carried out under controlled conditions, ideally within 48 h from the collection of the donor unit. The preparation of leucocyte‐depleted blood components should be subject to a quality monitoring programme designed to assure 100% compliance. Indications for leucocyte‐depleted blood components RECOMMENDED Febrile nonhaemolytic transfusion reactions (FNHTRs) 1 To prevent recurrent FNHTRs after red‐cell transfusions, buffy coat‐depleted red‐cell concentrates should be used, if they are available, or alternatively red‐cell concentrates filtered at the bedside. 2 If FNHTRs continue despite these measures, leucocyte‐depleted red‐cell concentrates should be used. 3 To prevent FNHTRs in patients likely to be dependent on long‐term red‐cell support, the use of buffy‐coat‐depleted or bedside filtered red‐cell concentrates should be considered from the outset of transfusion support. 4 The routine use of pooled platelets derived from buffy coats is associated with a low incidence of FNHTRs. The use of platelet concentrates leucocyte‐depleted prior to storage is recommended for patients with reactions despite the use of such components. Bedside filtration of platelet concentrates is not recommended for the prevention of FNHTRs associated with platelet transfusions. Reducing graft rejection after haemopoietic cell transplantation: Patients with severe aplastic anaemia who are potential haemopoietic cell transplant recipients should receive leucocyte‐depleted blood components from the beginning of transfusion support. The same might apply to patients with haemoglobinopathies, but more evidence is required before a definite recommendation can be made. Prevention of transmission of viral infections by blood transfusion: Leucocyte‐depletion of blood components is an effective alternative to the use of CMV‐seronegative blood components for the prevention of transfusion‐transmitted CMV infection to at‐risk patients. Fetal/neonatal transfusions: Leucocyte‐depleted blood components should be used for intrauterine transfusions and for all transfusions to infants below 1 year of age. POSSIBLE Platelet refractoriness: There is currently no convincing evidence that routine leucocyte‐depletion of blood components produces clinical benefits for patients receiving multiple platelet transfusions, although HLA alloimmunization and platelet refractoriness are reduced. Kidney transplants: Pretransplant blood transfusion may confer some benefit to renal transplant recipients, although some patients will become alloimmunized leading to difficulties in the selection of donor kidneys. Consideration should be given to the leucocyte‐depletion of transfusions to renal transplant patients to prevent HLA alloimmunization unless they are part of a deliberate pretransplant immunosuppression protocol. Immunomodulation...

Human leukocyte antigen alloimmunization prevention mechanisms in blood transfusion

“…[ 23 ] These are 40 mm filters designed to remove microaggregates of fibrin, platelets, and WBCs from RBC concentrates. [ 24 ] Newly designed filters (third and fourth generation) are capable of removing up to 3 logs (99.9%) of contaminated WBCs. [ 25 ] They have pores ranging from 5 to 50 mm and are able to meet current hemocomponents’ quality standards.…”

Perioperative Transfusionskriterien

“…Trotz einer eindrücklichen Reduktion an postoperativen Infektionen nach Tumoroperationen bei Verwendung von leukozytendepletierten Erythrozytenkonzentraten an Stelle von buffy-coat-freien Erythrozytenkonzentraten wie zum Beispiel in einer Untersuchung von Jensen und Mitarbeitern [22], gilt eine Tumoroperation heute (noch) nicht als allgemein akzeptierte Indikation für leukozytendepletierte Erythrozytenkonzentrate [5,23]. Die Indikationen für leukozytendepletierte Erythrozytenkonzentrate sind in Tabelle 2 zusammengefaßt.…”

“…Die Indikationen für leukozytendepletierte Erythrozytenkonzentrate sind in Tabelle 2 zusammengefaßt. Aus diesem Grund wird empfohlen, Schwangeren mit unbekanntem oder negativem CMV-Serostatus entweder CMV-seronegative oder leukozytendepletierte Erythrozytenkonzentrate zu transfundieren [5,23] (Tabelle 2). Auch der Einsatz von leukozytendepletierten Erythrozytenkonzentraten bei ᭤ HIV-positiven Patienten wird nicht allgemein als indiziert erachtet [5,23], obwohl es Hinweise in der Literatur gibt, daß der weitere Verlauf einer HIV-Erkrankung durch eine nicht leukozytendepletierte Erythrozytentransfusion kompromittiert wird [23].…”

“…Wie bereits erwähnt, ist zu berücksichtigen, daß bei CMV-seronegativen Schwangeren oder Schwangeren, deren CMV-Serostatus unbekannt ist, CMV-seronegative respektive leukozytendepletierte Erythrozytenkonzentrate angezeigt sind [5,23]. Spezielle Transfusionsrichtlinien sind deshalb für Schwangere nicht erforderlich.…”

Association between Blood Group and Change in Coagulation Factors in Plasma Preparations for Transfusion Purpose at Kisii Teaching and Referral Hospital

“…An association existing between plasma von Willebrand factor and ABO blood group and coagulation factor VIII levels has not been well known. Blood group non-O individuals show signifcantly increased threat of arterial and venous thrombosis [4], whereas blood group O persons manifest hereditary bleeding tendency and vW disease [5].…”